On-Line Secure Registration for Integrative Breathwork Workshop, Dallas, TX, July 10-12, 2009

Integrative Breathwork Workshop - Registration

Secure On-Line Registration

Eupsychia Institute presents…
Integrative Breathwork & Soul-Based Psychology with Jacquelyn Small, Julien Devereux and Grace Annie Peterson

JULY 10-12, 2009
DALLAS, TEXAS

Order By Phone or By Mail • Cancellation Policy • Email Eupsychia
Return to Workshop Description

Name (First and Last): (If you are paying for more than one person, please fill out a separate form for each attendee. Thanks!)
Mailing Address: (include apartment numbers or suite numbers)
City:	State:
Country:		Zip/PostalCode:
Home Telephone (w/ area code):
Work Telephone (w/ area code):
Email Address:
Do Need A CEU Certificate or Attendance Certificate? ($15 extra):
Authorized Amount:
Payment Method:
Credit Card Number:
Expiration Date:
Verification Code on Credit Card: (For Visa/MC/Discover the last 3 digits on back of card): AmEx (4 digits on front of American Express above cc #):
Billing Address of Credit Card if different from above: \|
Additional Comments: Do you need a response to your comment? (If yes, please make sure you give us your email address and phone number in the appropriate fields above.)
By pressing the "send" button, you are authorizing Eupsychia Institute, Inc. to charge your Credit Card the amount you have indicated above... After submitting your registration you will be automatically directed to our on-line Confirmation Letter for this event. We will also mail this form to you with the necessary enclosures. Thanks! We look forward to seeing you in Dallas!

If you prefer to order by phone, please call us toll-free at:

(800) 546-2795 or Locally in Austin at (512) 327-2795

Or, you can mail your check or money order to us at the following address:

Eupsychia Institute • PO Box 151960 • Austin, TX 78715-1960

Cancellation Policy: Your deposit, less a $40 administration fee, will be refunded to you when cancelling up to two weeks before this event. Should you cancel within two weeks and before 5 days of this event, your remaining deposit may be used toward your attendance at a future Eupsychia-sponsored workshop held within a 12-month period from this workshop's start date. If no notice of cancellation is given, Eupsychia reserves the right to keep your entire deposit. Cancellation policies may differ from event to event. This policy is accurate for this event.