Aziza Healing Adventures

                 Relationship Patterns & Behaviour Workshop

                                                Registration Form

 

Date:  __________________

Cost:   $_________________

HST % ________________

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