Name of Workshop Name of Workshop Horse, Spirit & Play The Ravenheart Way Zen of Art & Horses

First Name

Last Name

Email Address

Phone Number

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

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

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

If YES, please list dietary considerations below

Please indicate your experience with horses Please indicate your experience with horses None Some Experience Lots of experience I own a horse

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

If YES, please indicate how many nights If YES, please indicate 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, please indicate allergies below If YES, please indicate allergies below Pets Chemicals Fragrance

Emergency Contact Full Name

Emergency Contact Phone Number

Emergency Contact Emergency Contact Relative Friend Neighbour