JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Winter Retreat 2021 Registration
Sign in to Google
to save your progress.
Learn more
Name
Your answer
Phone Number (Cell)
Your answer
Phone Number (House)
Your answer
Email Address
Your answer
Days I will attend
Saturday, February 27 (half day)
Saturday, February 27 (full day)
Sunday, February 28 (half day)
Sunday, February 28 (full day)
How did you find out about this workshop series?
Your answer
Payment ($30 all day, $20 half day)
Your answer
Or donation amount
Your answer
Method of payment:
E-Transfer. Send to:
asafer@nf.sympatico.ca
. Security Question: What month were you born? Answer: December
Cheque: Drop off at 58 Pennywell Rd.
Cash: Drop off at 58 Pennywell Rd.
Clear selection
Thank you!
The information on this form will be kept confidential by Safer Mindfulness, and will not be shared with a third party.
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report