EmailMe Form - Grace Cirocco Wise Warrior Weekend

Select A Date *

Full Name *

First Last

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Cell Phone

### - ### - ####

Other Phone

### - ### - ####

Primary Email *

Secondary Email

Food Allergies

How did you hear about this workshop?

Occupancy *

Single Occupancy

Double Occupancy

Please Note: Single rooms are not guaranteed but every effort will be made to accommodate you.

If you clicked on "double" room, Grace will assign you a roommate.

Friend's Name

First Last

If you are registering with a friend and would like to room with him, please type his name above.

Deposit of $1000 CDN is required to guarantee your reservation. *

Credit Card - We accept MC & VISA. Leave your card #, expiry, & > number on the back on our secure landline (24 hours) 905-688-0868

E-transfer - Please send to grace@gracecirocco.com Fast & easy, your amount will be auto-deposited.

Please click submit to enter the form. Please only click submit once and wait for the confirmation message.