Talleres de Mujeres Registration
Complete form below to signup for the workshop.
Name
First Name
Last Name
E-mail
example@example.com
Phone Number
DOB
Ethnicity/Race
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact
Phone Number
Any Diet Restrictions
Which workshop would you like to attend for 2023?
Winter - December 2
Workshop Donation
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USD
Description
Pay with PayPal
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Please click one of the PayPal options to complete payment and
submit
the form.
Complete Registration
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