Workshop Name: _____________________________________________ _____Date: _______________
Cost: $____________________
H ST 13% ______________Deposit: $__________________
Balance due: $______________
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___________ Related Personal Growth experience, if any:_____________________________________________________ ______________________________________________________________________________________ Previous AHA Workshops or Retreats_________________________________________________________
How did you hear about us?___________________________________________________________________ If lunch is included, please note any food allergies and considerations: __________________________________ ________________________________________________________________________________________

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 are filled on first to pay basis. Your position is held with a 50% deposit, which becomes non-refundable 21 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.
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