Oct 2024 Shadow Work®️ Weekend

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Enter First and Last Name *

Address *

Cell Phone # *

Email Address *

What weekend do you want to attend? *

Oct. 11-13 in Houston, TX

Oct. 18-20 in Loves Park, IL (Chicago area)

How did you hear about the weekend?

Shadow Work Website

Referred by Friend

Referred by Therapist

Found on internet

Other:

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Why do you want to attend the weekend? What do you want to get out of it?
*

The cost of the weekend is $750. There is a $200 non-refundable deposit due at registration. Payment can be made by Paypal (Friends and Family option greatly appreciated- QR code below), Venmo (QR code below) or Zelle at acewd@yahoo.com.

If you would like to pay another way, please contact Andrea Ray at acewd@yahoo.com.

People who register by Sept. 1st will be given an early-bird discount of $51 bringing price down to $699.

Registration will not be complete until $200 deposit is received. Payment can be received through Venmo, Paypal (Friends and Family option appreciated), or Zelle (acewd@yahoo.com)

*After you have registered, a facilitator will call you to discuss your involvement in the weekend. If, for some reason, the facilitator feels this weekend would not be a good fit for you, all of your deposit will be refunded'

The facilitators wish to make this seminar available to all. If payment and/or funding is a problem, please contact Kim Siongco at email.kim@email.com or Andrea Ray at acewd@yahoo.com.

How do you intend to pay?

I am registering with my $200 non-refundable deposit

I am registering and paying the whole cost of my registration including my $200 non-refundable deposit

Who would you prefer a call from? (We will try to accommodate all requests, however, we can't guarantee that we will be able to grant it.)

Kim Siongco

Andrea Ray

Maxim Imass

Doesn't Matter

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1. I understand that parts of this seminar may be emotionally triggering. I affirm that I am mentally and emotionally able to participate.

2. I understand that I can choose not to participate in any element of the weekend for any reason.

3. If I am uncomfortable physically, mentally, or emotionally, I commit to communicating with a facilitator who will work with me to make me as comfortable as possible.

If you agree to the above, please put your signature on the line below.

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