Vidaluna Continuing Education
Registration Form
Name___________________________________________
Address_________________________________________________________________
City, State, Zip_____________________________________________________________
Email___________________________________________________________________
Phone_(hm)_____________________(wk)__________________(cell)______________________
Emergency Contact_____________________________________________________________
Class you are registering for______________________________________________________
How did you find out about this class?_____________________________________________
PreviousMassage/Health/medical/healing/doulawork_______________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
___________________
Special areas of interest in
Massage/Healing___________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
____________________
Do you have any special needs (allergies/disabilities)?
________________________________________________________________________________________
_________________________
What do you plan on doing with this training?
________________________________________________________________________________________
___________________________________
Are you working towards any certifications/liscensures?
________________________________________________________________________________________
______________________
Please fill out this form and send it in with your deposit. Please send check or money order to:
Luna Wood
603 Pine Siskin Dr.
Buda, TX 78610
512.445.0020
Payment:
Womyn's Wellness Weekends/ Vidaluna Doula Certification
Womyn's Wellness Weekends/Luna’s Doula Certifications Series requires a $450 deposit to hold your space for
the complete training and/or $150 deposit for each weekend.
The cost for this training is $375 ($360 early bird fee) for one weekend or $1025 for the complete training. Your
balance will be due in full 2 weeks prior to the first day of the training. There will be additional fees for
certification and /or the mentorship program. These fees will be due at a later date if you wish to continue
training with Luna Wood.
Deadline for deposit is January 1,2009.
CEU Classes
For most 6 Hr. CEU's the cost is $125. For special classes the price may vary. The cost of the class you are
taking is__________.
How much deposit are you paying or have you paid? $________________
Your balance will be due in full 2 weeks prior to the first day of the training.
Payment Programs and Work trades: Payment for classes are agreed upon, prior to class in written contract
form. This option does cost a bit more so, ask for details. The work trade position offers a discount for a specific
number of hours assisting Luna Wood with the upcoming training. This position is also agreed to in a written
contract form prior to class. If you do not complete your work trade by the end of the program you will be asked
to remit payment for the rest of the amount owed. There is a limited number of work study and payment plan
positions available and these are filled on fist come, first serve basis.
Make up Classes: You will have to wait until the class is taught again in order to make up and you will not
receive a refund for lack of attendance.
About the classes: The training makes once 5 people have registered. If it does not make there will be additional
classes held in the future and your deposit will be refunded. The program will close at 12 people.
Withdrawing from the program: If you need to withdraw from the program full deposits are refundable up to 1
month prior to the class, after that time, your deposit will be forfeited. Once the class starts and the balance is
paid in full there is no guarantee of a refund since someone else could have held your spot. Refunds are
determined on a case by case basis.
Other class and mentorship opportunities will be available throughout the year and announced on the monthly
newsletter. Please contact me with any questions at 512.445.0020 or luna@vidaluna.com.
I have read the above information and agree to all terms.
__________________________________ ___________________________
Signature of student Printed name
