The Light of the Moon: Opening Ourselves to the Wisdom and Joy of the Feminine.
When: August 24, 25, 2019.
Please fill out this form and include your payment to reserve your spot.
If you are sending a cheque or money order, please print, sign and send this form with it.
The information provided shall be kept confidential.
Your First Name(s) *
Your answer
Your Last Name(s) *
Your answer
Your email *
Your answer
Your phone number (If I already have it, just write you have it.) *
Your answer
Your address (If I already have it, just write you have it.) *
Your answer
Please tell us how you found out about this course.
The more specific you are, the better we will know how people are finding me and my work. Thank you!
Your answer
How will you be paying? (Please choose one) *
$250.00 (tax included) when paid before April 30, 2016. $295.00 (Tax included) when paid on or after May 1, 2016.
RELEASE OF LIABILITY: I take full responsibility for my experience. I understand that I may leave these meetings at any time for any reason. I understand that this workshop may bring up issues of a highly personal nature that may cause me to experience emotional or physical responses that may be unexpected and/or unpleasant. Further, I understand that I may experience mental, emotional, physical, or spiritual distress and that such distress may cause unpleasant feelings. What is experienced in this workshop/training may create physical responses on my part or on the part of other participants. I understand that there is the risk of accident, injury, and emotional distress. I agree to assume this risk, including but not limited to the types of responses described. I confirm that I do not suffer from any mental or physical impairment, and have not been diagnosed at any point with a disorder, condition, or injury, either physical or mental, that might make it inadvisable for me to assume such risks. This workshop is designed as an educational venue only. This workshop is not designed as a substitute for therapy or as a substitute for any other form of professional consultation. By clicking below, I willingly agree to the preceding statements and to hold harmless from all liability, the facilitator, the organizers, and all participants and observers attending this workshop. *
CANCELLATION POLICY: For cancellations made 10 days or more prior to the start of the training, you will receive a refund minus a $120.00 administration fee. No refund will be given for cancellations made within 9 days or less before the course start date. In the case of a session cancellation, a full refund will be given.
Your answer
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service