Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

If you register for all 3 days, you get a FREE T-shirt!! What size would you like?

They will be Unisex short sleeve shirts

Small

Medium

Large

XLarge

2 XLarge

Additional Information *

check all that apply:

Traditional Scrap

Digital Scrap

Would you like a "Just the Scalp" treatment with our Licensed Esthetician Kaitlynn Barrett at an additional charge? (if this box is checked, one of our staff members will be reaching out to you to schedule your session during the event! She will have several price points and length of treatment options to suite your needs!)

Would you like a facial with our Licensed Esthetician, Kaitlynn Barrett at an additional charge? (if this box is checked, one of our staff members will be reaching out to you to schedule your session(s) during the event! She will have several different price points and length of treatment options to suit your needs!!)

Would you like a Massage with our Licensed Massage Therapist, Whitney Effinger at an additional charge? (if this box is checked, one of our staff members will be reaching out to you to schedule your session(s) during the event! She will have a few different price points and options from full body massage to chair massage. These are booked at a 1st come, 1st servie basis as registrations come in. LIMITED SPACES!

What days will you be attending? *

Please check all that apply AND which days you will be attending. If attending all 3, you get a FREE Tshirt!!

Day 1

Day 2

Day 3

By checking the box below, you understand that your spot is NOT secure until payment is received. Once payment is received, Jennifer at Mind Body Balance Breathe will immediately text or email you to let you know YOUR IN!! Due to spaces being limited, all registrations with payment will take precedence. This is due to limited spaces!

Yes, I understand and will send payment with registration! Payment can be sent via Venmo (on flyer above), cash or check at the time of registration, or stop by the studio to register. Email invoice from Mind Body Balance Breathe is also an option. Please reach out to Jennifer at 308-365-2169 OR by email at mind.body.balance.breathe@gmail.com to request an email invoice.

Date

MM

DD

YYYY