NurtureWorks Workshop Registration Form

Please fill in and submit this form to reserve your place at my NurtureWorks event. Your place will be confirmed when payment is received.

Thanks for sharing your personal data. NurtureWorks is committed to safeguarding your privacy and will never share your data for marketing purposes. Any health data will be kept strictly confidential. See my Privacy Policy.

NurtureWorks Workshop & Event Registration Form

First Name *

Surname *

Date of birth *

Email *

Phone

Which event or workshop would you like to book? *

How many places would you like to book? *

If booking for more than one person, please give your friend's name and email address

Would you like to book 'extras' (eg 1-2-1 therapies), if available?

Any comments (eg health issues or anything else it would be useful for me to know), special needs (eg dietary requests, if relevant) or questions?

How did you find out about the workshop? *

Would you like to receive my NurtureWorks news (occasional newsletter about upcoming workshops, retreats, new classes, plus some Yoga and Qigong insights) You can unsubscribe at anytime? (If you are booking for 2, your friend will not be added) *

Yes

No

Prices and Payment

My preferred method of payment is by credit/debit card through this form. I only accept other forms of payment in exceptional circumstances. If you have agreed this with me in advance and are not paying now, please select 'Other' as your payment option.

Prices (per person unless stated. Please select option) *

WomenWell in the Wild - 1 person - £40

WomenWell in the Wild - 2 people - £70

Payment options *

Pay now with credit/debit card

Other (ie no payment right now). Please add details:Other (ie no payment right now). Please add details:

Credit/Debit card payment

Name on card

Credit Card number

Expiry date

If you are human, leave this field blank.