The Gabrielle Borkan Institute

WORKSHOP REGISTRATION FORM

PO Box 1535, Mill Valley, CA 94942

Phone 415-388-2898

Constellation Workshops with Gabrielle Borkan

Phone (cell):

Address:

Phone (work):

Email:

State:

Zip Code:

Profession:

Phone (home):

I wish to register for the following Workshop:

Date:			Location:
Organizer:

I wish to participate as:

q Working participants: $325 (A deposit of $100 will hold your space)

q Witnessing participants: $185 (A deposit of $100 will hold your space)

Please note: Everyone who attends has the opportunity to participate in constellations as a representative.

q Please send me airport and hotel information

Cancellation and Refund Policy:

Refunds are available minus a $50 processing fee if notice of cancellation is given 10 days prior to workshop begin.

I understand that this is a self-exploration workshop and not a substitute for psychotherapy or medical treatment. I take full personal responsibility for my experience during this workshop.

Signature

Date

Please mail this registration form with your payment (check or money order payable to Gabrielle Borkan) to the address above (please do not email). We will send you a confirmation letter that includes all the necessary logistical information about the workshop upon receipt off your registration form and payment.