AYA WHB Super Weekend Registration Form & Scholarship App.

WARRIOR / HEALER / BUILDER Juneteenth
Choose or attend them all!

1. Araminta -The Warrior-Healer-Builder Story Fri (Free)

2. Independent and/or Home School Education / Plus 2-hour FREE Session ($0.00) Sat. 10 AM - 12 PM Face-2-Face and Streaming online

3. Taste of WHB: 4-Hour Workshop 1-5 pm ($45) Sat.

4. Brothers Only 7pm-9pm Saturday ($25)

5. Sisters's Only 7pm -9pm Saturday($25.00)

6. UPCOMING - 3-Day Weekend Retreat ($349.00) TBA Fall of 2016

7. Scholarship Application

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Date Date / MM / DD YYYY
Name Name First Last
Cell Phone Cell Phone - ### - ### ####
Email
I'm Registering For: (Choose all that apply)

I'm Registering For: (Choose all that apply) Atlanta (Dec. 10th, 2016) Dayton, OH (Feb. 24-25 2017) Columbus, OH (April 15-15, 2017) Tallahassee, FL (Jan, 2017 TBA) Other Other

Choose all that you want to and plan to attend.
I'm Registering For: (Choose all that apply)

I'm Registering For: (Choose all that apply) Araminta WHB Fri. 7:-9:30pm (FREE) Araminta- TWHBS Certification Intro 9am (Free) African Centered Ed / WHB Intro (Free) WHB Taste 1-5 pm Sat. ($45) Brothers Only 7-9pm Sat. ($25) Sisters Only 7-9pm Sat. ($25.00) WHB Full Weekend Retreat (Fall TBA) ($349) Other Other

Choose all that you want to and plan to attend.
3 Installment-Payments

If you need to make 3 installments for the WHB Taste (3@$15 =45)
or the Full Weekend Retreat TBA 3@ 116.33 = $349
I need to make recurring payments. I will make the first of three now.

I need to make recurring payments. I will make the first of three now. $15.00 (1/3 of the $45.00 payment) $116.33 (1/3 of the $349.00 payment)

Make your first payment now and you're registered to attend. You'll be contacted for your commitment dates for the remaining 2 payments.
I will make the 2nd of three now.

I will make the 2nd of three now. $15.00 (1/3 of the $45.00 payment) $116.33 (1/3 of the $349.00 payment)
I will make the FINAL of three now.

I will make the FINAL of three now. $15.00 (1/3 of the $45.00 payment) $116.33 (1/3 of the $349.00 payment)
What interests you most about AYA's WHB Program or how have you benefited so far?
I would like to stay connected with AYA Educational Institute. Please sign me up for AYA's

I would like to stay connected with AYA Educational Institute. Please sign me up for AYA's Email list TXT 180 Texting Program Invite me on Facebook (FB)
Would you be willing to invite others to these WHB opportunities?

Would you be willing to invite others to these WHB opportunities? Yes No Other Other
Scholarship Section

Please use this section to apply for scholarships. Thank you for asking.
Scholarship For WHB Super Weekend. Brothers and Sister Session. Please explain how much help you need and a brief statement explain why you want to attend.

AYA WHB Super Weekend Registration Form & Scholarship App.

AYA WHB Super Weekend Registration Form & Scholarship App.

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Total

3 Installment-Payments

Scholarship Section

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