Holotropic Breathwork dates TBA
Name:______________________________________ Phone: ( )_________________________
Address:______________________________________________________Zip_____________
E-mail: _____________________________________________ Date:_____________________
Is this your first Holotropic Breathwork? __ Yes __ No
____$75 deposit (cash balance due by date of workshop)
____$120 postmarked 14 days before workshop OR ____$135 postmarked after that date OR
____$125 Pay Pal for Dori ____$141 Pay Pal for Dori
By registering for this workshop, I understand the medical contraindications and I acknowledge that they do not apply to me. I also understand and accept the payment and refund policy.
____________________________________________________________________________
Signature Date
Please send a check payable to Dori Langevin or PayPal with this signed registration form to:
Dori Langevin 4612 S. Schafer Branch Rd, Spokane, WA 99206