eu workshop — registration form

EU WORKSHOP: AN INTENSIVE

IMPORTANT: Please fill out a registration form and pay for each workshop attendee individually. If you wish to pay by check or money order rather than by PayPal, please contact sschirott at hotmail dot com for instructions.

All fields, including your title, are required unless otherwise noted.

Title:

First Name:

Last Name:

Email:

Address line 1:

Address line 2: (only if needed)

City:

State/Province:

Zip code / Postal code:

Country:

Phone Number. Include area code. If outside US include country code (eg. +61 = Australia)

Please indicate any special dietary requirements for the banquet meal:
NoneVegetarianVeganGluten free:
How would you like your name to appear on your workshop name badge?

Additional Comments (optional):

NOTE: To minimize the amount of spam we receive through our site, the following question MUST be answered correctly for us to receive your registration:
 

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