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.?
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Do you have a medical diagnosis or are on any medications?
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What specific skills do you hope to learn from this group process experience? What gifts might you offer to others?
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Do you have any nutritional (food) or physical restrictions?
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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:_______________________________________________________________