| Event(s) you are registering for: |
|
| Dates: |
|
| Location |
|
| Name |
|
| Address |
|
| City |
|
| State |
|
| Zip Code |
|
| Telephone/Mobile |
|
| Fax |
|
| Email |
|
| What would you like to receive from this workshop? |
|
| Do you have any health issues that may affect your participation? |
|
| Do you have any food allergies or abstinences? |
|
| Have you participated in workshops or trainings of a personal growth nature in the past? |
|
| How did you hear about this workshop? |
|
| Is there anything specific you would like us to know about you? |
|
| |
|