AUTHENTIC SELF - Self help, Personal Development - Motivation, Self Confidence, Happiness, Goal Setting & Change Management

Workshop Registration Form
Once a payment has been placed to reserve your seat please fill in below

Name
Address
Mobile
Email
Workshop Attending
Date of Workshop
Amount Paid
Paypal Receipt No
Direct Deposit Description
Is a VIP joining you?	Yes No
VIP name joining you	(This person will also need to fill in this form)
Special dietary needs (Vegetarian / gluten free etc)