Please fill out the following information and mail this form to:

Lynda McKenzie,
128 Wilson Drive,
Milton, Ontario L9T 3J9
CANADA

Name(s) ________________________________________________________

Address_________________________________________________________

City____________________________________________________________

Country_________________________Tel: ___________________________

Enclosed please find (payable in Canadian funds please) either:

100% Payment ($80 per person)...................Cdn$____________

or

50% Payment ($40 per person)....................Cdn$____________

Interested in the Friday get together:...........Yes_____No_____

Bringing something for the marketplace:..........Yes_____No_____

Preferred Complementary Therapies:

                         (Least important)   1   2   3   4   5   6   (Most important)
PARTICIPANT #1:
Naturopathy.................................___ ___ ___ ___ ___ ___
Movement /Dance therapy.....................___ ___ ___ ___ ___ ___
Homeopathy..................................___ ___ ___ ___ ___ ___
Meditation..................................___ ___ ___ ___ ___ ___
Tai Chi.....................................___ ___ ___ ___ ___ ___
Neurofeedback...............................___ ___ ___ ___ ___ ___
Reiki.......................................___ ___ ___ ___ ___ ___

PARTICIPANT #2:
Naturopathy.................................___ ___ ___ ___ ___ ___
Movement /Dance therapy.....................___ ___ ___ ___ ___ ___
Homeopathy..................................___ ___ ___ ___ ___ ___
Meditation..................................___ ___ ___ ___ ___ ___
Tai Chi.....................................___ ___ ___ ___ ___ ___
Neurofeedback...............................___ ___ ___ ___ ___ ___
Reiki.......................................___ ___ ___ ___ ___ ___