Growing Your Potential from the Wisdom of your Roots Registration Form

Thank you for your interest in this course. Once your registration form is received you will receive an email confirming your place in the course. Payment details will be sent to you in this email. You must be 18 years or older to participate in this course.

Name(required)

Email(required)

City (required)

Phone Number(required)

What part of Ireland are your ancestors from and when did they emigrate to America?(required)

Have you visited Ireland?(required)

Yes No

How did you hear about this course?

Do you have a daily meditation practice?(required)

Yes No

I HEREBY CONFIRM THAT

I agree to the Terms & Conditions (required)

View terms and conditions

I have read and agree with the Cancellation Policy (required)

I am 18 years or older(required)

Submit

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