Submit Registration Form Then Pay According to Method of Payment Chosen

REGISTRATION FORM

Yes! I Want to Register & Pay for The Following Sessions

Name

Phone (for Our Records only)

Address (for Our Records Only)

PLEASE CHOOSE ONE:

SUNDAY OCTOBER 11, 2026 (1 SPOT LEFT)
SUNDAY OCTOBER 18, 2026 (1 SPOT LEFT)
ADD ME TO WAIT LIST FOR NEXT DATE

PLEASE CHOOSE ONE:

BOTH SESSION $35 (SESSION TWO INCLUDED) ART FROM THE HEART SESSION ONE ONLY $35
SESSION ONE: ART FROM THE HEART ONLY $35
SESSION TWO: LAUGH YOURSELF HEALTHIER ONLY $10

METHOD OF PAYMENT: (Please Choose One)

PAYING by Credit Card or PAYPAL after Submitting This Form
PAYING by BANK $ TRANSFER after Submitting This Form
PAYING CASH (DROPPING OFF AHEAD OF DATE TO HOLD MY SPOT

SEND BANK $ TRANSFERS & PAYPAL PAYMENTS TO:
empowermentstartshere@gmail.com