Personalized Class Request Form Name * First Name Last Name Email * Phone * (###) ### #### Goals I want to learn I want to perfect We want to practice as a group Location Vibrations Om - Lachine Vibrations Om - Pointe-Claire Vibrations Om - Saint-Laurent Send someone to my location For how many people (Approx) 1 person 2-5 people 6-10 people 11-20 people More than 20 people Anticipated number of sessions One-Time Session Regular Weekly Sessions No sure yet Prefered Language French English Bilingual Address if requesting corporate classes Address 1 Address 2 City State/Province Zip/Postal Code Country Message * Merci • Thank you!
