Shimmering Heart Registration form

& Payment

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Name *
Name
Please indicate what your gender is, if any.
Please let us know if you are either coming on Saturday, Sunday or Both
Please tell us if there is something we need to know about your health that may affect you in the Sweat Lodge e.g heart problems, anxiety etc.

All the information provided will be kept strictly confidential

Sweat Lodge and Cacao Ceremony

Pay to account: R. Ayala Silva, Sort Code: 07 02 46  Account Number: 47743721, Ref: Sweat Lodge