Full name * First Name Last Name Email * Phone number * Please note that if I can't reach you by email, I will send you a text message (###) ### #### Have you been part of any of my classes, workshops, or private practice ? * Yes! Not yet! What are you hoping to experience during our time together? * In a few words, what are some of the biggest challenges you experience in your cycle? * How did you hear about me? * Where do you live (city and country)? * *To purchase your ticket : Canada: Please send your payment via e-transfer to stephaniemankarios@gmail.com and write your FULL name + name of this program in the 'note' section of the e-transfer. USA: please send your payment via VENMO (or Zelle). Once I receive this form + your payment, I will email you to confirm that you're in! * Please note that simply filling out this form does not ensure that you have a spot in the workshop! On it! Thank you for filling out this form! Once you send the payment I will send you an email to confirm that your spot has been reserved! Join Empowered Cycles
