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Chrysalis Heart Center 2008 Workshop Registration

To register for any workshop or a Track or workshops, please fill out this form completely and send the appropriate payment. You will receive an email confirmation of your registration with a detailed list of your registered classes.

Because we honor the time and energy our teachers put into their classes:
Pre Registration is required at least 24 hrs in advance for all classes!

If you sign for a series of classes, pre-payment is requested after 1st class.

Make check or money order out to Donata Ahern.
Credit and or debit card payments accepted. We will send you a PayPal request after receipt of this registration form.

Email: chrysaliscenter@roadrunner.com
Mail: POB 82, East Aurora, NY, 14052
Phone: 716-652-0301

NOTE: PLEASE BRING SLIPPERS OR SOCKS TO THE WORKSHOPS.

Name * First Last
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Daytime Phone * ### - ### - ####
Evening/Cell Phone * ### - ### - ####
Please provide the number we can reach you at best.
Email *
Workshops You'd Like To Register For *

Please enter the workshops you are registering for, separated by commas for multiple entries.
Total Cost of Workshops * $ Dollars . Cents
Please add up the cost of your workshops and enter here.
I would like to pay by:
Would you like to receive email updates from Chrysalis Heart Center with news on upcoming workshops and special events>
Yes, Please! No thanks
Do Not Fill This Out

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