Email this form if you are using pay pal or you can post with

booking deposit to:

 

Carolyn Curtis,

Empowering Workshops,

24 Summerstown Road, 

Wilton,

Cork City,

Ireland

Name:

 

 

Address:
 
 

 
 
Phone land line:
 
 
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Email address:
 
 
Please state the name & location of the course/workshop you wish to book:

  

  

State the date of the course/workshop:
   

 
   
Have you been on a course/workshop with me before?

   

      

   

Where did you hear about this workshop or my website ?   

  

      

    

    

 

    

 

 
Why would you like to attend this course/workshop?