Process Group Registration Form

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Building Soul Events

Process Group Registration Form

Please print and fill out this form, return it by email or fax below along with proof of payment. Feel free to contact us if you have any questions or concerns.

                                Phone: 866.888.7662

                                Fax: 866.888.7662

                                E-mail: ingrid@buildingsoul.ca

Name:________________________________________________________________

Address: ______________________________________ City:___________________

Email:________________________________________________________________

Province/State: ________________________________________________________

Postal Code/Zip:________________________________________________________

Home Phone: __________________________________________________________

Work Phone: ___________________________________________________________

Cell Phone: ____________________________________________________________

Email: ________________________________________________________________

Emergency Contact:_____________________________________________________

Relationship: ___________________________________________________________

Emergency Phone: ______________________________________________________

Workshop Name: ______________________________________________________

Date:______________________ Cost:_______________HST _____________

TOTAL:____________________DEPOSIT:__________________

FINAL  DUE:___________DATE DUE:____________Pd By:_____________

Why would you like to participate in this workshop?

______________________________________________________________________

______________________________________________________________________

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What experience do you have with Bioenergetics, body mind therapy, somatic psychotherapy, psychotherapy, etc.?

______________________________________________________________________

______________________________________________________________________

Do you have a medical diagnosis or are on any medications?

______________________________________________________________________

______________________________________________________________________

What specific skills do you hope to learn from this group process experience? What gifts might you offer to others?

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

Do you have any nutritional (food) or physical restrictions?

______________________________________________________________________

______________________________________________________________________

Where did you hear about Building Soul or this event?

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Participant Cancellation: Refunds will be provided to those who cancel his/her enrollment at least two weeks prior to the commencement of the workshop, minus a $50 processing fee. No refunds will be given for cancellations within two weeks of the workshop.

WORKSHOP CANCELLATION: WE RESERVE THE RIGHT TO CANCEL SEMINAR/WORKSHOPS DUE TO INADEQUATE ENROLLMENT AND OTHER CIRCUMSTANCES BEYOND OUR CONTROL. IN THE EVENT OF A WORKSHOP CANCELLATION, WE WILL REFUND YOUR REGISTRATION FEE IN FULL.

TO REGISTER FOR ANY WORKSHOP OR SEMINAR, PLEASE SEND A PAYMENT BY EMAIL MONEY TRANSFER, MAIL OR ON OUR WEBSITE THROUGH PAYPAL THEN SEND THE FILLED-OUT REGISTRATION FORM AND PROOF OF PAYMENT TO US BY EMAIL, FAX OR MAIL. THANK YOU.

SIGNATURE:_________________________________________________________

DATE:_______________________________________________________________