Ekstasis Dance w/ Luna

First Name
Last Name
Email Address
Phone Number
Address
City
Province
Postal Code
Which Series or Workshop are you registering for?	Kundalini Dance Intro Night Kundalini Dance Weekend Kundalini Dance Series Vancouver 8 Day Awakening Retreat
Which location are you taking the Intro Class or Weekend Workshop?
How would you like to pay?	credit card money order paypal
Do you need help finding accomadations?	Yes
Do you have any health concerns (ie. epilepsy, mental illnes, heart conditions)??
How did you find out about this workshop/series?? (If it was through a friend please include their name if possible)

Comments

Please submit this registration form, and you will go to a page with more information about payment options to complete your registration.

Join my e-newsletter to recieve valuable information on the healing power of ecstatic dance and advance notice on upcoming events.

Name

Email

City

(Your personal info is kept strictly confidential.)

"It is my firm belief that Luna's work in cultivating her authentic self has allowed her to be a channel for vibrationally enlivening forces as an ecstatic dance medium. Though a significant bar to live up to, it is clear from the expressions of those who attend her workshop that it would be highly unlikely to find any dissent in these words." - Manoj, promoter, Orbital Monkeys


	Luna Ravenchilde Ekstasis Dance luna@ekstasisdance.com www.ekstasisdance.com 778.868.7534