REGISTRATION FORM

 Workshop/Class/Retreat Name (check one):

BodyTalk           Body Talk Access         Qi Qong          Family Constellation        Retreat

Workshop/Class/Retreat date:

Name:     

Address:

City:           Province:    Postal Code

Home Phone:                       Work phone:

E-mail: 

 

Payment Information – Please print neatly

 

 

Method of Payment:  Check         Cash          Visa/MasterCard              American Express

 

Name (as on card)

Billing Address (if different) Postal Code:

 

Card No.  CVV2* Exp. Date

             *CVV2 is the 3-digit code in signature area on back of card for VISA/MC/Discover

            *CVV2 is a 4-digit non-embossed code on front of AmEx

 

Signature:  Deposit: $

                                                                   Remaining Balance: $

Make checks payable to: Pathway Medicine

Please arrange payment method with the Coordinator, Heather Marchand.

 

 

*** FOR FAMILY CONSTELLATION WORSHOPS ONLY:

Level of participation (check one):  Active Participant    Participant   Guest

 

If you have any physical limitations of any kind, or medical conditions, or schedule of taking medication – please kindly let us know:

Referred by:  

 

1)   You can register over the phone at (403) 616-7215, or via e-mail heather_pathwaymedicine@yahoo.ca
  You will need your Registration Form filled and signed.
2)50% deposit is required to hold your place.
 3) Full payment required to be processed for at least 14 days before Workshop start day.
4) Cancellations received less then 14 days before the seminar have a non-refundable processing fee of 30%, less then 7 days – 50%. 
5) In case of any unforeseen circumstance or emergency the full deposit can be applied towards any future seminars.
6) All personal information will remain private and confidential for instructor use only.

 Registration and Cancellation Policy