Heartwork/Artwork Registration

Name   _________________________________________________

Address   ____________________________________________

City                             State________  Zip_________

Telephone (home) __________________ (work) ____________________

e-mail _____________

Church____________________________          

CONTRAINDICATIONS:  Heartwork/Artwork is not appropriate for people with history of severe psychiatric disorders.  Anyone who has had a severe recent trauma, major surgery, or has any questions is asked to contact Jody before the conference.

Jody Soland        

e-mail- songbirds100@aol.com

phone: 330-945-6412