I confirm that I am registering for Movement, Well-Being & Your Vagus Nerve at Dance Life Studio, Sunday, December 15, 2019

Yes

Name

First Name

Last Name

Email Address

Phone number

Will you be applying for CE credits through Yoga Alilance?

Amount to be Invoiced, According the Sliding Scale between $40-60?

If you require a deeper sliding scale, please let me know what you could afford to pay. Yoga for all!

Would you like your invoice via PayPal or Venmo or the CashApp?

Pick one of the following 4 choices: PayPal user name

or Venmo User Name

or CashApp user name

Or do you need to pay by check?

If you need to pay by check, please indicate that you understand that your place in the workshop will not be confirmed until receipt and deposit of the check (checks payable to: Ruthie Goldman. Send to: 535 S Owen Drive, Madison WI 53711):