Blue Skies Ahead! Pre-Registration

Name*
First Last
Email*
Address*
Street Address Address Line 2 City Province Postal Code
Phone
In order of what you prefer to use
Phone #1*
Phone #2
Phone #3
What is the best time to call you?*
Can I leave a message?*
- Yes
- No
Any concerns about phone calls
Anything you feel that I need to know that is not covered in this form?
Would you like to receive new posts from The Separation Project once per month?
- Yes

Register by Phone: 289-237-4419 – ask for Pam.
Register by Email: Pam@TheSeparationProject.ca – please put ‘register me’ in the subject line.

I will call you to confirm your spot in the class and to arrange for payment closer to the start of class. A receipt will be emailed when the payment is processed.

Blue Skies Ahead! Pre-Registration

Phone

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