Holotropic Breathwork

Registration Form

Name _____________________________________________________

Address ___________________________________________________

City _________________________   State _____    Zip _____________

Phone (day/work) [______]________________ Phone (evening/home) [______]_______________

         Phone (cell) [______]________________ 

Email address  __|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__

Register me for the following date(s): _____________________________

Tuition enclosed $____________ 
Holotropic Workshop early registration tuition is $120 (NY) / $110 (NJ).
No Frills workshop early registration tuition is $65.
You may send a $50 deposit.
Cancellations received one week in advance are refundable. Between one
week and one day before the workshop, a $25 processing fee will be applied.
After this, payments are nonrefundable.

We will contact you and/or send a confirmation letter with directions and 
other pertinent information prior to the workshop. 

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