Vilma Pinedo Workshop Registration Form
Please fill this out as much as possible, as it will help us be aware of your needs during workshops.
Email *
First Name *
Last Name *
Phone Number *
Person to contact in an emergency and their contact number. *
Medical History (Physical/Mental) Are you on any medication? *
Current Condition (Physical/Mental/Emotional) *
What has drawn you to this workshop?  *
Hopes and expectations for this workshop *
How did you hear about this ? *
Please tick this box if you are happy for Ali to add you to her database. Please refer to Terms and Conditions for GPDR statement: *
Required

Vilma Pinedo Bundle: If you chose to come to both the Cacao and Rose ceremony on 17th May and the pilgrimage on 18th May, please indicate which contribution you are intending to make below, thank you. If you choose the concession option, please email: enquiries@alirabjohns.com to discuss further.

Please note that we are asking for a deposit of £50 to secure your place within the circle. 

This is a non-refundable deposit, UNLESS you provide us with 2 weeks notice to cancel, or find another person to fill your place.   Note that a £15 administration fee will be deducted from any refunded deposits.

Whilst we make every effort to keep the contributions low to enable people to participate, we just cannot afford to return deposits if people drop out at the last minute; our outgoings remain the same regardless of how many people attend. 

Thank you for your understanding. Please write your name and date below as a signature, stating that you have read and understood this information.
*
PAYMENT DETAILS VIA PAYPAL:

Please pay all deposits and contributions to the account detailed below to secure and book your place. 
Please contact Ali if you would like an invoice and if you are wanting to pay via Stripe (international payments).

Important note:  To help us keep track of your payment, please reference your transfer in the following way:
FULNAME; VILMAPINEDO
FULLNAME; VILMAPINEDO
( Please make sure you tick the friends and family option; if using Paypal*) THANK YOU!
*
Required
Statement of self authority and absolution
I have read all the information that I have been sent and will ask any questions that I need to ask.  I consent to stepping into this process for my own healing and transformation, knowing that I am doing it within my own self authority and autonomy.

By attending these workshops I accept full responsibility and will not hold any of the organisers, sponsors, or medicine carriers responsible or accountable for my experiences in any way. 

I will follow all guidelines given to me before, during and afterwards and understand that I can ask for and will receive any support that I need.
*
Please contact us if you have any questions or concerns - enquiries@alirabjohns.com
Or use this box to share anything else that we may need to know.
we are very much looking forward to sharing with you in sacred circle.
For all our relations!
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