Name *

First Name

Last Name

May I add you to Vibrance Matter's email list for my energizing workshops, healing groups, interesting newsletters and private session promotions? Your email address is always kept confidential. My email mailing are about monthly. *

No thanks

YES! PLEASE!

Best Contact Phone *

(###)

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

REGISTRATION FEES (Deadline to avoid late fee is Wednesday, May 6, 2015): *

1-Day GETTING the LOVE YOU LONG FOR Workshop held on Saturday, May 9, 2015 ~ $ 150

Late Registration Fee for registrations received after Wednesday, May 6 , 2015 Workshop ~ $ 50

Discounts:

Early Bird Discount (Registration and pre-payment in full received by midnight, Sunday, May 3, 2015 ( - ) $25

Attending with one (1) friend discount ( -$25)

Attending with two (2) friends discount ( -$50)

Other Discount code (type in discount code & $ amount below)

I am paying in full at this time by: *

Paying in full by credit card now.

Paying in full by check that I will mail with a copy of this form. I realize my registration must be receive by Linda Greenfield's office by Wednesday, May 6, 2015 to avoid a late registration fee of $50/ workshop.

Credit Card Company that I am using: *

MasterCard

Visa

American Express

Refund Policy: *

Refunds for Registration Cancellations are only provided to requests made in writing and received by Wednesday, May 6, 2015. No refunds are offered for registration cancellations after Wednesday, May 6, 2015 or for non attendance to Workshops. Refunds (less $50 fee) will be refunded by check via mail by 5/20/2015.

I understand and accept this refund policy.