Eagle Dance Registration Form

Eagle Dance Registration Form

Centre for Shamanic Arts Eagle Dance 5-7 June 2026
Name

First NameLast NameMedicine Name
Birth Date

MonthDayYear
Address

Street Address

Street Address Line 2

CityCounty

Post Code
E-mail
example@example.com
Phone Number

Country codeArea CodePhone Number
Role at ED
Cost
Please pay by BACS to the following account

Bank: Virgin Money
Name of account: Centre for Shamanic Arts
Sort Code: 05-08-03
Account number: 21758392

And for overseas payments:
IBAN: GB76YORK05080321758392
BIC/SWIFT: YORKGB21803

In case of difficulties paying by BACS, please contact Pete at moonsnakepe@gmail.com
I will be on the land by 2pm Thursday 4 June to be part of the prep crew
Signature

Medical Authorisation Form