contact us

Use the form on the right to contact us.

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123 Street Avenue, City Town, 99999

(123) 555-6789

email@address.com

 

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Link to read me page with more information.

Registration (short form)

Short Form for Registration

Please use this form only if:

  • There have been no changes in your address/employment/medications/health and
  • It has been less than 2 months since your last FSS workshop.

**PLEASE NOTE: I am offering the services provided in these workshops as a physician under my medical license. The information gathered on this form is necessary to provide optimal services to you, while also meeting the medical charting requirements of the Alberta College of Physicians & Surgeons. Some services are covered by the Alberta Health Care Insurance Plan, which is indicated in the description of each workshop. All information provided is confidential as per the Health Information Act (HIA) of Alberta. Thank you. *

Please select workshop(s) you are registering for: *
If you are interested in coming out for the whole day please select the morning and afternoon workshops for that day.
Name *
Name
Birthday *
Birthday
**AHCIP Card must be presented at workshop** (Enter 9 digit number without spaces)
Phone (Home) *
Phone (Home)
Phone (Cell) *
Phone (Cell)
E.g. Meditation, Time in Nature, etc.

**PLEASE NOTE***
3 business days notice is required for cancelling the spot being held for you in a workshop. 

Cancellations made after this time will be subject to a fee of $20/scheduled workshop hr:

3 hr workshops:  $60

6 hr workshops: $120

8 hr workshops: $160