Conscious Connected Breathwork Circle - Individual Registration

First Name *

Last Name *

Phone *

Email *

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Please enter the amount you can afford to pay, without a dollar sign, suggested donation $15-25 per class. No one will be turned away due to inability to donate *

By completing this registration I confirm that I have read and understood the breathwork waiver, and I am aware of the potentional benefits and risks, and I take full responsibility for my wellbeing during the workshop. *

I agree

Amount

$

Payment processing fee

$

Gross amount

$

Payment Method

Paypal or Credit Card

Credit Card Number*

Expiration Date*

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Card (CVV) Code*

Card Holder Name*

Important Info

Ongoing Classes/Events

Individual Registration

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