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Spring Self-Care Share Registration Apr. - Jun. '21
Thank you for your interest in the Spring Self-Care Share. After you submit this form, you will be contacted by email to set-up / confirm payment. Please email Jennifer at
joyifer@gmail.com
with any questions.
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What is your name?
Your answer
Is this for you, or is this a gift for someone else? If a gift, please list the recipient's name here.
Your answer
How will you be paying?
Check
Cash
Venmo
Clear selection
Will you be picking up your share, need it delivered locally, need it boxed for sending, or sent by mail to recipient?
Pick-Up
Delivered (Additional $10. Must be Blacksburg, Christiansburg or Radford for delivery service)
Boxed for sending (Additional $15)
Share shipped to someone in the U.S. (Additional $45)
Clear selection
What is your preferred email address to receive correspondences and mindfulness practice recordings? If this is a gift, please list gift recipient's email address here as well.
Your answer
What is your address? If a gift, please include gift recipient's address here as well.
Your answer
What is your phone number in case you must be contacted about your share? If a gift, please include gift recipient's phone number here as well.
Your answer
Do you have any allergies / health concerns that we should be aware of in preparing your herbal share?
Your answer
Any other questions / information you would like to share? If so, please share below.
Your answer
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