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Workshop Name: _____________________________________________
_____Date: _______________
Cost: $________________HST 13% _________Deposit ______________ Balance
________________________
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:
- ______________________________________________________________________________________
- ______________________________________________________________________________________
- ______________________________________________________________________________________
Emergency Contact: Name____________________________________________Relationship____________
Address___________________________________________________Phone:________________________
Booking and Cancellation Procedures: All prices are in Canadian
dollars unless otherwise specified. Our workshops and retreats are filled
on first to pay basis.
- Relationship Patterns Workshops in Toronto: Your position
is held with a 50% deposit, which becomes nonrefundable 45 days prior
to scheduled Relationship Patterns workshops. Balance is due at 45
days. Bookings made less than 45 days before workshop date require
full, nonrefundable payment.
- Couples Retreats: Your position is held with a 50% deposit,
which becomes nonrefundable 45 days prior to scheduled retreat. Balance
is due at 60 days. Bookings made less than 45 days before retreat
date require full, nonrefundable 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.
Initial ____________
I have read the web pages outlining the program I am
registering for and understand that I will participate in therapeutic
creative exercises and group discussions.
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 your application to: Aziza Healing
Adventures, 59 Crewe Avenue Toronto, Ontario, Canada M4C 2J2 Phone:
416-696-0086, fax: 416-696-0087, e-mail: info@aziza.ca
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