Class Registration Form All Classes

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**If you have filled this out recently for another class, you do NOT need to fill it out again unless you have updated info to share.

CURRENT CLASSES:

Exploring the Vagus System Part 3 (Nov 9-11, 2024 In person weekend)
Exploring the Vagus System Part 3 (starts Feb 3, 2025, Mon 2-5pm)
Organs and the Vagus System (Feb 21-23, 2025 in person weekend, Virginia Beach)
Biodynamic Approach to Craniosacral Therapy, Part 1 (Apr 5-7, 2025 in person weekend)
Biodynamic Approach to Craniosacral Therapy, Part 2 (May 24-26, 2025 in person weekend)

Birthing Yourself Process Workshops (use this form instead)
PPN 2-Year Study Group (use this form instead)

PAYMENTS:

After completing your registration form, your payment confirms your spot. We prefer payment by Venmo, Zelle, or check:

Venmo @Janet-Evergreen
Zelle to janet@janetevergreen.com
Check to Janet Evergreen 115 RiverBluff Circle, Charlottesville, VA, 22902.
To pay via PayPal, credit card, or debit card, go to the "Classes" page on Janet's website: www.janetevergreen.com/classes. Scroll down to the correct class and click the "Payment" button.

REFUND POLICY:

Classes are limited in size and require payment to confirm your registration. If class has not already begun and we can refill the spot, we are happy to give a full refund minus $50 or use your full payment for a future class.
Exception for Birthing Yourself and PPN - If the workshop/class is more than a month away and we can refill the spot, we are happy to give a full refund minus $50. Less than a month away, no refunds will be given unless your spot fills.

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Janet Evergreen, MA
115 RiverBluff Circle, Charlottesville, VA 22902
(434) 906-4181
janet@janetevergreen.com
www.janetevergreen.com

For more information about classes and where they will be located, please visit the
Classes page on Janet's website.

Email *

Course Title: *

Course Date/Time: *

Name and Credentials (as you wish to appear on your certificate) *

Address: *

Telephone Number: *

Communication Preferences: *

Check if you text message.

Check if you are willing to share your phone and email contact with your class.

Required

Birth Date and Age: *

Familial Status (i.e. married, partnered, single, divorced, children, grandchildren...) *

Emergency Contact Person and Phone Number: *

Are you a bodyworker who would like to receive NCBTMB continuing education credits?

(If yes, we will send you the appropriate form.)

yes

Class Agreements *

I understand this is a somatic-based teaching and experiential inquiry. I will take responsibility for my own mental health and wellbeing during retreat.

I agree to uphold confidentiality for this group.

Required

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