JizoWorkshop Registration Form

Name

First Name

Last Name

Email Address

Phone

(###)

###

####

Emergency Contact

First Name

Last Name

Emergency Contact Phone

(###)

###

####

What days will you attend?

Friday

Saturday

Sunday (morning)

Will you need overnight accommodations?

Yes

No

Do you have any dietary restrictions?

Anything else?

Please let us know if you have any questions or concerns about this sesshin.

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