Class Registration Form Name(Required) First Last Phone(Required)Email(Required) I'd Like to Register for the Following: Gem Circle - First Session: Complimentary ($0.00) Gem Circle - Single Small Group Breathwork Session ($30) Gem Circle - Two-Session Small Group Breathwork Package ($50) Gem Circle - Six- Session Small Group Breathwork Package ($120) Gem Circle - Twelve- Session Small Group Breathwork Package ($225) Beginning with Breathwork - Two Part Class: $30.00 Individual Beginning with Breathwork - Two Part Class: $50.00 You and a Friend One-Month (2 Sessions) Small Group Breathwork Membership ($50) Six-Month (12 Sessions) Small Group Breathwork Membership ($225) (Payment will be collected separately via our Payment Form after your registration is processed.)To protect this form from SPAM please answer the following: What goes up, must come ______.(Required) Sapphire Breathwork About BreathworkAbout TereseOfferings Contact (413) 552-9729(914) 817-0313tkatzphd@gmail.com