Full Day Workshop Registration Form
Name ___________________________ Phone
_____________________________
Address
_______________________________________________________________
Email _________________________________________ Gender
________________
Allergies
_______________________________________________________________
Strong food dislikes
______________________________________________________
Medical conditions and
medications __________________________________________
________________________________________________________________________
Psychiatric
conditions and medications
_______________________________________
________________________________________________________________________
Physical
handicaps, such as difficulty hearing, cannot sit on floor easily, etc.
________________________________________________________________________
I
have____ years experience with energy work. What type?________________________
I give
permission for my address, phone, and email to be put on a list and given to
all
participants. Yes____
No____
For The
Homestar School only; please include a two page letter telling the basic
struggles
of your
recent life and a description of your relationship with God/Goddess.
Mail form to: Jill Kelly, P.O.Box 16, Shutesbury, MA 01072