(* denotes a required field)
Workshop Date: *(required)

First name: *(required)

Last Name:

Email address: *(required)

Telephone number: *(required)

Street address/PO Box no:

City:

State/Province:

Zip/Postal Code:

Country:

Below are some questions to help me gear
each workshop towards participants' needs:

How did you hear about this workshop?

Do you have any experience in
meditation or working with energy?:
(note - experience is NOT necessary, just
a love of animals and an open mind)
Yes No

Have you taken any previous workshops?
Yes No

If Yes, what were they?

What is your occupation or your interests?

Do you have pets now or in the past? What kinds?

Your intended method of payment: PayPal Cheque Money Order VISA (by phone)

In submittion this form I declare that I have read Georgina Cyr's Animal Communication Code of Ethics and agree to the Waiver.