Spirit Babies - Healing Womb Grief 2017

Thu 15 Jun 2017 to Sunday, June 18, 2017

Thank you so much for your interest in our weekend immersion - Spirit Babies - Healing Womb Grief. Please take a moment to fill in the Registration Form below and we will be in touch with payment options via email. All of your information remains Private and Confidential and will not be shared forward. Much love Kate and Sharon xxx

Registration Form

* Required Fields

First Name *

Last Name *

Email *

Mobile *

Country

Street Address *

Suburb *

State *

Post Code / Zip *

Date of Birth *

Occupation *

Next of Kin: Name and contact number *

Are you allergic to any food or have any food preferences, eg, vegetarian, vegan, gluten free, dairy free, raw food etc. *

Do you have any current medical conditions that we should know about that could impact your ability to participate in this weekend (physical or mental)? Please include full details. *

Have you had any mental issues or are currently dealing with mental issues (psychosis, schizophrenia, severe depression, severe anxiety etc)? * *

Yes

If YES, please give full details if this is a current or past issue.

Please take some time to tell us your story and what is calling you to attend this Workshop. *

Are you willing to take full responsibility for your health and safety, over the weekend? *

Yes

Would prefer a King Single Room or Twin Share? *