Massage Workshop RSVP

You may print and send this form to Dr Kornylak, or email the information to "kornylak at earthlink.net"

1. Names and e-mail addresses of you and any group members.

2. If you don't have a group, we will attempt to match up those without one. But we need some additional info from you. A standard group consists of 2 men and 2 women. If this is fine with you, just put "standard" if you are looking for another configuration, please state it in the RSVP.

3. We are holding this in 2 rooms as described in the announcement. Please specify your preference.

4. When we approve your RSVP, and match you with a group we will notify you, and you finalize your RSVP by payment of $12. You must also send or bring the signed DISCLAIMER with you.

So your RSVP will look something like this: (You can use this template to send in)

Name:___________________________E-Mail:___________________________

                                                                Phone:___________________________

Name:___________________________E-Mail:___________________________

                                                                Phone:___________________________

Name:___________________________E-Mail:___________________________

                                                                Phone:___________________________

Name:___________________________E-Mail:___________________________

                                                                Phone:___________________________

IF YOU ARE NOT A GROUP OF FOUR, AND NEED TO BE MATCHED:

Check one:              Standard_______   All male_______     All Female______

          Other: Please explain___________________________________________

ROOM PREFERENCE:     Sensuous Only_______    Fully Permissive_________

IF ANYONE IS A MEMBER OF HARP-PRIVATE, CIRCLE THE NAME ABOVE, otherwise please write briefly how you heard of this event, and what you hope to experience at this event: