Workshop Registration Form

CONTACT INFORMATION

Name

First Name

Last Name

Address (please include city, province, postal code)

Phone #

(###)

###

####

Email Address

Emergency Contact Name and Number

How Did you hear about these workshops?

If choosing referral or other, please provide more info

I am a current client

I found it on your website

Referrel

Other

WORKSHOP OF INTEREST

Please enter the workshop name and date you would like to attend in the space below

Preferred Method of Payment

Payment for all workshops is due 3 weeks prior to the workshop date.

E-Transfer (please send to maryannebrown@xplornet.ca)

Cheque: Made payable to Maryanne Brown 750 White’s Rd, Brighton ON K0K 1H0

Spaces for workshops may be limited. You will receive a confirmation of registration once the workshop spots are confirmed. At that time, method of payment should be confirmed.

Workshop Registration Form

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