Registration form

Name:


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Address:


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____________________________________________________________

Phone:                                             Email:


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Class


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Date:


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Amount enclosed

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I understand that Evolving Therapies Studio is not responsible for lost or stolen property. By signing this form, I acknowledge that Rebecca Lawson or Evolving Therapies Studio is not responsible for injury to my person or property.  I am participating in the class or workshop willingly and with personal responsibility.

 Signed:

 

 ___________________________________        Date:________________________________________