Waiver & Release

Name
[text* Name]

Address
[textarea* Address]

Phone
[text* Phone]

Phone (Work)
[text WorkPhone]

Email
[email* Email]

Birthdate
[text* Birthdate]

[acceptance Acceptance] I Agree to the terms outlined above

[submit “Submit”]

[your-subject]
no-reply@breatheyoga.ca
Name: [Name]
Address: [Address]
Phone: [Phone]
Work Phone: [WorkPhone]
Email: [Email]
Birthdate: [Birthdate]

Acceptance: [Acceptance]
angie@breatheyoga.ca

[your-subject]
[your-name] <[your-email]>
Message body:
[your-message]


This mail is sent via contact form on Breathe Yoga http://breatheyoga.ca
[your-email]

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Posted on: June 24th, 2013 No Comments

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