New Moon Cacao: Re-Source for Resilience (19 August 2020)

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Welcome! Please complete one form per person to register for this gathering.
The ceremony is from 19h00-22h00.
We will send you information to prepare for the evening a day before we meet.
We really look forward to sharing this beautiful ceremony with you.

Bienvenue! Merci de compléter une formulaire par personne pour s'inscrire à cette soirée.
La cérémonie sera de 19h00 - 22h00.
Tu vas recevoir plus d'informations le jour avant notre rencontre.
Nous nous réjouissons de partager cette belle cérémonie ensemble.

More information:
Georgina: georgina.peard@gmail.com / +41 79 219 4407

Contribution: CHF 70

Advance payments please to:
Georgina Peard
IBAN: CH87 8080 8004 1945 5013 8
BIC/SWIFT: RAIFCH22
Adresse: Georgina Peard, Chemin de Jolimont 2A, 1180 Rolle, Switzerland
Bank: Banque Raiffeisen de Gimel, 1188 Gimel, Switzerland.

Email *

Telephone *

First Name (Prénom) *

Last Name (Nom de famille) *

Are you taking any anti-depressant, anxiolytic or heart medication? Are you pregnant? Do you have low blood pressure? Have you had any previous epileptic fits? *

No - none of the above

Yes (please explain below so that we can see how best to support you)

Other:

Required

How did you hear about this event? (Comment as-tu entendu parler de cet événement?) *

Send me a copy of my responses.

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