Somatic Self-Compassion Self-Paced registration page

SSC Self-Paced

Please Note:
If you choose the PayPal option and are not taken to the PayPal page after completing this form, it's likely that you have missed completing one of the required fields. Please scroll down and check to see if there is an error message if you are not taken to PayPal.
About you:
General Data Protection Regulation (GDPR) Agreement*
- I consent to having this website store my submitted information so they can respond to my inquiry
Name*
First Last
Email address*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Course selection and registration:
Price*
Please choose your investment level below.
- I need a little support to join this program ($50)
- I can be here at the middle rate ($75)
- I can support scholarships ($100)
Coupon
Payment Type*
- PayPal/Credit Card
If you are paying by check, please make the check out to:
Kristy Arbon
HeartWorks Training
PO Box 510441
St Louis, MO 63151
Total
$0.00
Name
This field is for validation purposes and should be left unchanged.