Spring Self-Care Share Registration Apr. - Jun. '21
Thank you for your interest in the Spring Self-Care Share. After you submit this form, you will be contacted by email to set-up / confirm payment. Please email Jennifer at
with any questions.
What is your name?
Is this for you, or is this a gift for someone else? If a gift, please list the recipient's name here.
How will you be paying?
Will you be picking up your share, need it delivered locally, need it boxed for sending, or sent by mail to recipient?
Delivered (Additional $10. Must be Blacksburg, Christiansburg or Radford for delivery service)
Boxed for sending (Additional $15)
Share shipped to someone in the U.S. (Additional $45)
What is your preferred email address to receive correspondences and mindfulness practice recordings? If this is a gift, please list gift recipient's email address here as well.
What is your address? If a gift, please include gift recipient's address here as well.
What is your phone number in case you must be contacted about your share? If a gift, please include gift recipient's phone number here as well.
Do you have any allergies / health concerns that we should be aware of in preparing your herbal share?
Any other questions / information you would like to share? If so, please share below.
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