Please read the workshop information page first, then choose your payment options:
 


Print and fill out the Registration and Release forms below. Make your check payable to Brigitte Sztab and send  to:

Rick Roussey
BodyTalk Clinic
2750 Stickney Point Rd. STE 207
Sarasota, FL 34231-6000


Please print and send in the portion below_____________________________________________________________________________


Please register me/us for the Family Constellations workshop on ______________________
 

PLEASE PRINT LEGIBLY:
 

Name/s:

 

 

 

Address:

 

 

 

 

 

 

 

Phone:

 

 

 

Email:

 

 

I/We will be attending as: (  ) working participant, (  ) supporting participant

(  ) Enclosed is my/our deposit(s)        (  ) Enclosed is my/our full tuition of ____________  Please check workshop information for appropriate payment
 
In the event that the workshop must be canceled, you will be reimbursed for all fees already paid. If you need to cancel for any reason up to 4 weeks before the workshop, we will reimburse your deposit/workshop fee minus  a $30 administrative fee, after this date you may send somebody else in your place.

RELEASE FORM

I understand that Family Constellations is a self-exploration workshop and not a substitute for medical treatment or mental health therapy. I am in good physical and mental health. If I am under the care of a physician or therapist, I have informed them of the nature of this work and have their approval to proceed.I understand that I can ;eave the workshop at any time.

Brigitte Sztab  reserves the right to accept or reject any person as a participant at any time, and to make changes in the workshop or setting whenever deemed necessary for the comfort, convenience or safety of the participants, and to cancel the workshop at any time. In the event the workshop must be canceled, Brigitte Sztab and shall have no responsibility beyond the refund of moneys paid to them by participants for that workshop.

 By signing, the participant agrees that Brigitte Sztab shall not be liable for any damages, loss or expense occasioned by any act or omission by herself or any other workshop participant.
   
Print Name________________________________

Signed____________________________________

Date_____________________________________