HEALTH AND WELLNESS

REGISTRATION FORM “Life After Grief” Self care

NAME: __________________ First Nation:__________________
ADDRESS:________________ Occupation or other:____________
Phone Contact:______________

Please select which session attending. All sessions are the same and for 2 days

(Respectfully request no cell phones allowed on site during sessions)

________________________ ______________
Signature: Date:

Payment options: ___ $175.00 please make cheque payable to Bevann Fox
_____or deposit online by email fund transfer to bbfox@myaccess.ca
_____Mail cheque to address below

(Registration Fee: includes materials, DVD, nutritional refreshments, massage. There is a 30% cancellation fee)

Bevann Fox
P.O. Box 2725
Fort Qu’Appelle, SK S0G 1S0