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Exit 2012 workshop Registration
PLEASE RETURN FORM TO: EXIT INTERNATIONAL, PO BOX 4250 Bellingham wa 98227 fax 360-844-1501
Vancouver BC - Saturday 24 November: 1- 5pm; Unitarian Church, 949 49 AveW, Vancouver, (Transit: EB w 49 Av FS Oak St)
Registration Details
First Name........................................................................... LastName..................................................................................Address.......................................................................................................................Postcode................................................Email...............................................@.................................................................Phone........................................................... Date of Birth................................................Exit Membership No. ...................................................................................... Have you everbeen diagnosed with a mental disorder..NO.......YES..... (if yes, what is your diagnosis?)................................................. FREE - I am a member of Exit $100 - Annual Exit Membership(includes workshops) $50 - I am already a subscriber to the PP eHandbook $85 - Exit Seminar ONLY
TOTAL PAYABLE
Workshop Payment
Credit Card No..........|...........|...........|.............Name onCard...................................................... Signature.........................................................Expiry Date....................../..................................Mastercard
Visa
Cheque
Cash on the day
(Workshop attendees must be aged 50 years or over or seriously ill. Photo ID or medical records may be requested.) Afternoon Tea will be served. Exit Meeting & Workshop
vancouver bc, canada
Vancouver BC: Saturday 24 November 2012, 1 - 5pm Unitarian Church, 949 49 Ave W, Vancouver (Transit: EB w 49 Av FS Oak St)
About Exit Meetings &...
PLEASE RETURN FORM TO: EXIT INTERNATIONAL, PO BOX 4250 Bellingham wa 98227 fax 360-844-1501
Vancouver BC - Saturday 24 November: 1- 5pm; Unitarian Church, 949 49 AveW, Vancouver, (Transit: EB w 49 Av FS Oak St)
Registration Details
First Name........................................................................... LastName..................................................................................Address.......................................................................................................................Postcode................................................Email...............................................@.................................................................Phone........................................................... Date of Birth................................................Exit Membership No. ...................................................................................... Have you everbeen diagnosed with a mental disorder..NO.......YES..... (if yes, what is your diagnosis?)................................................. FREE - I am a member of Exit $100 - Annual Exit Membership(includes workshops) $50 - I am already a subscriber to the PP eHandbook $85 - Exit Seminar ONLY
TOTAL PAYABLE
Workshop Payment
Credit Card No..........|...........|...........|.............Name onCard...................................................... Signature.........................................................Expiry Date....................../..................................Mastercard
Visa
Cheque
Cash on the day
(Workshop attendees must be aged 50 years or over or seriously ill. Photo ID or medical records may be requested.) Afternoon Tea will be served. Exit Meeting & Workshop
vancouver bc, canada
Vancouver BC: Saturday 24 November 2012, 1 - 5pm Unitarian Church, 949 49 Ave W, Vancouver (Transit: EB w 49 Av FS Oak St)
About Exit Meetings &...
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