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July 12-16, 2021
Medicine Wheel: Establishing Balance (in a Wonky World)

Registration Form for Online Class

Name_______________________________________________

Address_____________________________________________

City________________________________________________

State/Prov_____________Zip____________________________

Home Phone__________________________________________

Work phone__________________________________________

Email_______________________________________________

$270 Workshop Fee

   Check # ______ payable to HLCC

   Send through PayPal
        

   And/or, charge it using:
         MC Visa Disc AMEX

         CC#____________________________________ Security Code (3 digit code on back):______   Ex. Date:__________

By registering for this class I acknowledge that all materials are copyrighted and agree that the tuition and registration is per person attending, not per computer or other internet device. And that recording, reproduction, re-transmitting or distribution the class or its contents may only be done by explicit written permission of the teachers.

To register for this workshop please fill out the form above and mail it
along with your payment, to the following address.

Shannon Winsky
c/o HLCC
 261 E. Alegria Ave #12
Sierra Madre, CA 91024

OR,

Email s.winsky3@gmail.com to register with email,
please copy and past this registration filled out completely.

Questions? Please feel free to phone Shannon at (626) 602-4642.