Registration for Isla Burgess Immersion

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Weekend Immersion with Isla Burgess*
Please include any medical information that we should be aware of. Medical conditions, allergies, medications that you take and any other pertinent information. Also include an emergency contact person: name, address and phone number. This will help us in case of an emergency.
If you would prefer to send a check or money order please fill out this entire form and indicate below that you will be sending a check or money order. Send check or money order to Moonwise Herbs Confernce PO Box 166 Sheboygan,WI 53082. Please include your contact information, so that we can match your payment with this registration form.