Eupsychia Institute-Information Request/Feedack Form

Request to be notified of upcoming events

IMPORTANT NOTICE: If you'd like to be notified of upcoming events you MUST send us your email address. We will not be mailing as many brochures of events in the future.

When you are added to the email list, you will receive Small Talk, Eupsychia's email newsletter sent 2-3 times a year, which includes a substantive article by Jacquelyn Small, upcoming events, Eupsychia news and occasional special offers.

Please add the following addresses to your email program's address book: eupsychia@austin.rr.com and bshea@austin.rr.com

PLEASE SELECT INFORMATION TO EMAIL (You will be added to the mailing list. (emails are sent in pdf format)

• Eupsychia's Certification Program in Soul-Based Psychology (includes application).
Yes No

• Ten-Day Wellness Program (Healing into Wholeness) with Application (in-depth information about our 10-day intensive wellness program with application and psycho-social form and program logistics for the next program conducted 2x a year).)
Yes No

ADDRESS INFORMATION:

Name (First/Last)*

Address* (include apt/suite numbers)

City*

State/Province*

Zip/Postal Code*

Country*

Work Phone(include area code & ext)

Home Phone(include area code)

FAX number(include area code)

E-mail address*

required to receive Newsletter, order confirmations, etc.

* REQUIRED FIELDS

Comments & Feedback:

Response Requested: Yes No
Email Address, if not entered above. We will respond to most comments and feedback by email...

Home • What is Eupsychia • Eupsychia Founder • Integrative Breathwork• Certification Program• Upcoming Events • Telephone Coaching/Counseling • Secure Bookstore • Our Staff • Wellness Retreats • Our Next Healing/Training Workshop • Contact Eupsychia •

Eupsychia Institute • PO Box 151960 • Austin, Texas 78715-1960
(800) 546-2795 Local (512) 327-2795 Fax (512) 327-6043

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