Weekly Healing Workshop Registration

Name

Location (City, State)

Date Of Birth

Age

Phone Number

Gender

Have You Ever Received Any Type Of Helping Service In The Past (if yes, please specify)

Have You Ever Participated In A Workshop or Group Like This Before?

Are You Currently Receiving Any Helping Services? (If yes, please specify)

What Would You Like To Get Out Of This Workshop?

What Date(s) Would You Like To Attend The Workshop (Must Be A Saturday) ?

Additional Comments

(Spots Are Secured Only After Payment Is Received)

If You Have Any Questions, Please E-mail lhlifehealing@gmail.com or call 484-455-4542