Life Story Sign Up — Creative Interfaces

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The Life Story Workshop

December 13, 2017

Registration Form

Name *

Name

First Name

Last Name

Email *

Mailing Address *

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Your age *

Tell us about how old you are

Under 20

20 - 24

25 - 29

30 - 39

40 - 49

50 - 59

60 - 70

Over 70

Will you be participating as an individual, or as a couple? *

Individual

Couple

Which best describes your participation?

Check the boxes that best describe your motivation for participating in this workshop

I want to work on my personal spiritual growth

I'm sorting out past issues

It sounds fun

It was recommended by a friend

I want to contribute more to others

I'm intrigued by the idea

other (leave a comment below if you'd like)

How would you like to pay? *

$35 per person / $50 per couple

I'll pay online - send me a link to the payment page

I'll bring payment with me to the workshop

I already paid

My seat is provided as part of a group

I need a scholarship (one may be available - we will respond and let you know)

Today's Date *

Today's Date

YYYY

Send us a message or ask a question (optional)