Please complete the following contact information:

First Name
Last Name
E-mail Address
Phone Number	(Enter area code and number without spaces or hypens)
The above number is my	Home Phone Work Phone

Please select the date of the workshop that you plan to attend: Please select one of the following options 7/27/10 7/31/10 8/6/10 8/20/10 8/27/10 8/28/10

Please select the workshop that you plan to attend:

  Please select one of the following options Creative Livelihoods, Tuesday, 7/27/10, 10:30 pm - 12:00 pm Alexander Technique, Saturday, 7/31/10, 1:00 pm - 2:30 pm Ask the Pharmacist Medical Marijuana, Friday, 8/6/10, 12:00 pm - 1:30 pm Chemobrain Strategies, Friday, 8/20/10, 12:00 pm - 1:30 pm Celebration Circle, Friday, 8/27/10, 11:30 pm - 1:30 pm Special Drum Circle, Saturday, August 28, 7:00 - 9:00 pm

How many people will be attending this program (including yourself) ?

Please enter the names of any family or friends who will be attending with you in the spaces below.

Additional Name 1:

Additional Name 2:

Additional Name 3: