Secure Online Registration for Integrative Breathwork Workshop, Boca Raton (South), FL, February 24-26, 2012

Integrative Breathwork Workshop - Registration

Secure On-Line Registration

Eupsychia Institute presents…
Integrative Breathwork & Soul-Based Psychology with Jacquelyn Small and the Eupsychia Team

February 24-26, 2012
Boca Raton, FL

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:
Authorized Amount:
Payment Method:
Credit Card Number:
Expiration Date:
Verifcation Code on Credit Card: (The last 3 digits on back of card):
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 returning to Boca!

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 $50 administration fee, will be refunded to you when cancelling up to two weeks before this event. Should you cancel within three 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.