NAME:
PHONE
NUMBER:
MAILING
ADDRESS: (include city, state and zip code)
EMAIL
ADDRESS:
WHERE
DID YOU HEAR ABOUT THIS COURSE?
LIABILITY RELEASE FORM
Date_____________________________
I will not hold Beth Beurkens, Christina Ensminger, The Foundation for Shamanic
Studies, or the Granlibakken Resort & Conference Center legally responsible
for any injury, illness, accident or other misfortune that may occur in
connection with enrollment in the Way of the Shaman workshop at the Granlibakken
Resort & Conference
Center, Lake Tahoe, California on October 13 & 14, 2007.
Signature____________________________________________________________
Printed Name_________________________________________________________
CHECK
PAYMENT
Secure
your registration by putting your deposit or full tuition check
(made out to Beth Beurkens) in an envelope addressed to:
Beth
Beurkens, P.O. 840, Mt. Shasta, CA 96067
CREDIT
CARD PAYMENT
Please
fill out the form below with your original signature and full tuition
amount. Credit card payments may only be made for the full tuition amount.
PLEASE DO NOT
EMAIL THIS CREDIT CARD FORM. YOUR ORIGINAL SIGNATURE IS REQUIRED
TO CHARGE YOUR CARD. PLEASE FILL IT OUT, SIGN IT AND PUT IT IN AN
ENVELOPE ADDRESSED TO BETH BEURKENS, PO BOX 840, MT SHASTA, CA 96067
AND MAIL IT USPS.
Thank
you for your registration. We look forward to sharing the Way of the Shaman with you. |