Family/group registration form

Please complete this form if you are signing up for the 21 August event, and will be including family or group members in the event. All info that is shared is treated with complete confidentiality.

Questions 1 - 6 require an answer, Q7 and Q8 are optional.

Thank you for registering your group in the event. We will be in touch with you soon via e-mail.

If you would prefer to send the form to us via e-mail rather than through this site, then instead of clicking on the "Done" button when you have completed the questions, copy and paste the form into the body of an e-mail, and send it to earthhealadmin[at]gmail[dot]com

* 1. Name:

* 2. E-mail address:

* 3. Please let us know the number of adults, seniors, children and animals in your group (including yourself):

  One Two Three Four Five
Seniors (over 65)
Children (under 18)

* 4. Please list the names of all the participants in your group (f known), including yourself:

* 5. Please indicate which method was used to pay for your group's participation:

* 6. Date of payment:

* 7. Please tell us how you heard about this event:

* 8. If there is any other relevant info you would like to share with us about the group or family being included in the event, please do so in the  box below: