5Rhythms workshop enrolment/ enquiry

Yes! I would like to register for a 5Rhythms® workshop
or just ask some more questions

If you are registering for a workshop, please fill in the whole form, then pay your deposit

* Indicates required field

Name *

First

Last

Email *

Please put me on your mailing list for info about future classes and workshops. *

yes, please no thanks

This retreat/workshop appeals to me because *

My secret wish... what I most deeply yearn to receive from attending this workshop *

Any anxieties, worries, niggles *

Please briefly list any health issues (physical, emotional, mental), and what your needs to do with these would be on the workshop *

Are you taking regular medication? *

I have paid *

full workshop payment full workshop earlybird payment I haven't paid anything yet

Comments or questions *

Emergency contact name and email or phone *

My relationship with my instincts is *

My relationship with power is *

My relationship with my Vision is *