Which Event Would You Like to Attend? Which Event Would You Like to Attend? Wild at Heart Writer's Retreat Colour for your Life Horses, Spirit & Play Retreat Starstruck Retreat Ravenheart Way Retreat Individual Equine-Assisted Learning Session Zen of Art and Horses Horse Powered Reading

First Name

Last Name

Phone Number

Email Address

Street Address

City

State / Province / Region

ZIP / Postal Code

How did you hear about this workshop? How did you hear about this workshop? Word of Mouth WHOLife Journal Flyer / Poster Website Internet Search Facebook

What is your experience with horses? What is your experience with horses? None Some Experience Lots of Experience I own a Horse

Do you have any dietary needs? Do you have any dietary needs? YES NO

If YES, what are they?

Do you need accommodation? Do you need accommodation? YES NO

If YES, how many nights? If YES, how many nights? One night only Two nights More than two nights

Do you have any allergies? Do you have any allergies? YES NO

If YES, which of these allergies? If YES, which of these allergies? Pets Chemicals Fragrance

Emergency Contact Full Name

Emergency Contact Phone Number

Who is your Emergency Contact? Who is your Emergency Contact? Spouse Relative Nieghbour Friend