A Continuing Journey 2011-2012 Registration

www.WhatsNextWorkshop.com

A Continuing Journey Reg

PLEASE NOTE - "A Continuing Journey" is only available to What's Next?! Workshop Alums who have completed at least one full series.

Once you complete the application below and click submit, you will be redirected back to this page for payment. If you would like to secure your space via PayPal scroll to the bottom of the page and click the "Buy Now" button. If you prefer to pay by check, please make your check payable to Joanne Lutz and mail it to: 12 Moulton Road, Arlington, MA 02476.

First Name: *
Last Name: *
Street Address 1: *
Street Address 2: *
City: *
State: *
Zip Code: *	(5 digits)
Best Phone: *
Alternate Phone: *
Email Address: *
In Case of an Emergency, Contact: *
Emergency Contact's Phone Number: *
Relationship to Emergency Contact: *
What is inspiring you to participate in "A Continuing Journey?"*
Do you have a specific intention for yourself that you would like support with over this next year? *
Other information you'd like to share or questions you may have...