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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. Thank You.
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Mount Shasta, California
Saturday, September 10, 2016 - 9:30 AM to 5:00 PM
Sunday, September 11, 2016 - 9:00 AM to 4:30 PM
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Registration:
Before August 10, 2016 $245.00
After August 10, 2016 $265.00
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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?
_________________________________________________________________________________
LIABILITY RELEASE FORM
Date _____________________________
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I will not hold Beth Beurkens, Beth Beurkens Seminars, the Foundation for Shamanic Studies, Richard Russo, or Della Clark legally responsible for any injury, illness, accident or other misfortune that may occur in connection with my participation in the Way of the Shaman workshop at the Spiritwalkers Retreat Center in Mount Shasta, California on September 10 & 11, 2016. |
Signature ____________________________________________________________
Printed Name ____________________________________________________________
PLEASE PRINT AND SEND VIA US MAIL. DO NOT EMAIL
Please include a registration form and liability waiver for each individual.
Beth Beurkens, M.A., P.O. 483, Ashland, OR 97520
[email protected] www.shamanicuniverse.com
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