EVENT REGISTRATION FORM

Name of Event:__________________________________

Date of Event:___________________________________

Your Name:_____________________________________

Telephone#:____________________________________

Address:_______________________________________

______________________________________________

City:___________________________ State:__________

Zip Code:_____________

Email (Please Print Clearly):_________________________

Deposit required with registration through 30 days prior to event. Balance required after 30 days prior to event. Full payment required with registration 30 days prior to event or later.

I understand that both deposit and full payment are non-refundable.

_____________________________________________

Signature

Complete this form and mail it with your non-refundable deposit made payable to:

Linda Paoli, LCSW
3433 American River Dr., Ste. A
Sacramento, CA 95864

For all events except Intensive Treatment Marathons:

Complete this form and mail it with your non-refundable deposit made payable to:

Charlene Conley, LCSW
1212 High St
Auburn, CA 95603

CALL NOW (916) 972-7831 or email Linda@Hearthealer.net and begin getting the life and love you want.

"A ship in harbor is safe — but that is not what ships are built for."

-J.A. Shedd