Medicine Circle

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Medicine Circle

Flagstaff Freemotion October 6-8, 2023

First Name *

Last Name *

Address *

Phone Number *

Email *

Payment Method $375 *

Cash, Check, Venmo (@Amelia-Gabelman) or Pay Pal (PayPal.Me/wiseroot)

Please make payment after submitting this form.

Cash/Check (payable ASAP at Sunday Dance or email FlgFreemotion to get mailing address)

Venmo (@Amelia-Gabelman, code: 0815)

Pay Pal (PayPal.Me/wiseroot)

Limitations

Do you have any physical limitations or psychological stresses in your life that could make this workshop challenging? Please answer yes or no. If yes, please describe.

Special Needs

Please describe any special needs that you have.

Liability *

I understand that I am wholly responsible for my health and safety for the duration of the workshop, from its advent to close, and hereby hold harmless Flagstaff Freemotion from any liability whatsoever resulting from my participation. Please answer yes or no and initial.

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