Aziza Healing Adventures
Relationship Patterns & Behaviour Workshop
Registration Form
Date: __________________
Cost: $_________________
Deposit/payment method: Visa cash cheque (payable to Aziza Healing Adventures)
Card
number_________________________________________________________ Expiry
date______/_____
Personal
Information
Name:______________________________________________________________________________
Address_______________________________________________________________________________
City:____________________________State/Province_______________Postal/Zip______________________
Phone# Home_____________________Wk______________________e-mail___________________________
Your
occupation__________________________________________Age__________
Gender_____________
Marital Status
____________________________________________________________________________
Related Personal Growth
experience, if any:_____________________________________________________
___________________________________________________________________________________________
Previous AHA Workshops or Retreats__________________________________________________________
How did you hear
about us?_____________________________________________________________________
What I am looking forward
to on this Workshop:
1.__________________________________________________________________________________________
2.___________________________________________________________________________________________
3.
__________________________________________________________________________________________
Emergency Contact:
Name____________________________________________Relationship_______________
Address___________________________________________________Phone:______________________________
Booking and Cancellation Procedures
All prices are in Canadian dollars
unless otherwise specified. Our workshops are filled on first to pay basis.
Your
position is held with a 50%
deposit, which becomes non-refundable 30 days prior to scheduled workshops and
45 days
before private workshops. Bookings
made less than 21 days before workshop date require full non-refundable
payment.
I am aware that personal growth
activities are designed to promote my emotional awareness and I accept full
responsibility for my emotional health during and after the workshop. I
acknowledge the enjoyment and challenge I receive from emotional risks involved
in participating in personal growth workshops and activities. I have read the
pertinent web pages or brochures regarding this workshop and understand it
involves creative activities and group discussion.
Initial
____________
Aziza Healing Adventures exercises the
right of discretion and with the sole intention of ensuring a positive
collective group experience can, at
anytime, decline applications from individuals who do not seem to be suited
to an AHA personal growth group
workshop.
I understand and
accept AHA Retreat Booking and Cancellation conditions.
Signature
________________________________________________________________Date____________________
Please mail or fax to: Aziza
Healing Adventures, 59 Crewe Avenue
Toronto, Ontario, Canada
Phone:
416-696-0086, fax: 416-696-0087, e-mail: info@aziza.ca