Registration form Fire and Ice Experience

First name

Last name

Date of birth

Address

Postal code

Recidence

Phone number

I hereby sign up for the following retreat/training:

Fire & Ice Experience for men

17 November 2024

Quart - Girona

€155

The reason I want to participate is:

I have the following dietary requirements (we eat vegetarian):

I have come into contact with Anahata center via:

Name and phone number of the person we can call in case of emergency:

Ultimatly, please fill out the next questions:

I declare that I have no mental or psychic illnessI agree that my email address and telephone number will be shared with the other participants of the workshop I am registering forI agree that my data will be stored for billing and information purposesI agree to the terms and conditions and I am aware of the cancellation policy

Room for additional comment:

Payment can be made in cash at the workshop or by Bizum prior or at the workshop.