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Fasting Weekend Registration

First Name

Last Name

Street Address

City

State/Province

Zip/Postal Code

Phone

Email

Medical Conditions

Allergies

Emergency Contact
Name & Phone

Date of Birth
MonthDayYear

Sex

Program Options

Date of Session

Payment Method

Please note that your registration is not complete until payment has been received.

Please Make Checks out to:
RSHC

Mail Checks to:
Rudolf Steiner Health Center,
1422 W. Liberty St.
Ann Arbor, MI 48103

We will telephone you for credit card information.

Refund Policy: cancellations 1 month or more from the start date are refundable minus a $20 admin fee. Cancellations at least 2 weeks from the start date receive a 50% refund, and cancellations within 2 weeks of the start date will receive a 50% credit which can be applied to the next event.