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REQUIRED WORKSHOP FORMS
Whether you are paying your tuition with Pay Pal, Check or Money Order,
you must fill out this two part registration form and mail it to:
Beth Beurkens, M.A. • P.O. Box 483 • Ashland, OR 97520
Along with your payment, this will complete your registration for the workshop.
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Santa Rosa/Cotati, California
Saturday, December 3, 2016 - 9:30 AM to 5:00 PM
Sunday, December 4, 2016 - 8:30 AM to 4:00 PM
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Registration:
Before November 2, 2016 $250.00
After November 2, 2016 $275.00
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| REGISTRATION FORM |
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Name ____________________________________________ Phone __________________________
Address (include city, state and zip code)
_________________________________________________________________
_________________________________________________________________
Email ________________________________________________
Where did you hear about this course?
_________________________________________________________________________________
Approximately when, and with whom did you take the Foundation for Shamanic Studies - Way of the Shaman course? (Prerequisite for any advanced FSS course)
_________________________________________________________________________________
LIABILITY RELEASE FORM
Date _____________________________
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I will not hold Beth Beurkens, Beth Beurkens Seminars, David Mojdehi, the Songbird Community Healing Center, or The Foundation for Shamanic Studies legally responsible for any injury, illness, accident or other misfortune that may occur in connection with my participation in the Shamanism, Dying & Beyond workshop at the Songbird Community Healing Center in Cotati, California on December 3 & 4, 2016. |
Signature ____________________________________________________________
Printed Name ____________________________________________________________
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