Rising Fire Program Waitlist Form

Medicine Wheel Session One

Waitlist Form
Thank you for your interest in Medicine Wheel. This is a first come first serve wait list. This waitlist ensures you will be notified when registration opens. Please fill out the information below accurately. When we open registration, we will send an invoice for ease of registration and payment so that your space is ensured.

The safety of your information is very important to Rising Fire and our Team. Please know we do not sell or use your information for anything other than communicating with you about our programs and events.
Please provide your contact details.
Name*

First NameLast Name
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Date
Email*
example@example.com
Mobile Phone Number*
Please enter a valid phone number.
Landline Phone Number (if applicable)
Please enter a valid phone number.
Agreement Statements
Check the circle to indicate you agree to the statement below*

I understand that this is a first come first serve waitlist.
Check the circle to indicate you agree to the statement below*

I understand that this is not preregistration; this holds a spot for me to be notified when registration opens.
Check the circle to indicate you agree to the statement below*

I have not made any payment for this program.
Check the circle to indicate you agree to the statement below*

Should I decide not to participate in the program, I will contact Rising Fire to be removed from the program waitlist as soon as possible.
Check the circle if this applies to you

I have taken this program before and would like to be included if there are any discounts for Rising Fire students.
Thank you for filling out the waitlist form You will be notified when registration opens.

Munay,

Team Rising Fire
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Date*

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Date
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Medicine Wheel Session One

Agreement Statements