Registration Body Image June 2018

Thank you so very much for taking the time to fill out this application. It will help me to gain a clearer understanding of how I can adapt the immersion to meet your needs.

Men are so very welcome to join us in this brave exploration of unwinding the feminine, yet do be aware that it is for the whole hearted (as opposed to the “faint hearted”) we will explore topics such as sexuality, intimacy and relationships, moon cycles, cycles of life and gender imbalance and how to find harmony. If you are a man interested in joining this course and you have any reservations then please do contact me directly and I can put you in contact with previous male participants.

Full Name *

First Name Last Name

Address *

Street Address

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E-mail *

Date of birth *

Gender

Female Male Other

Native language *

If you are not a native English speaker, please describe your English language proficiency (written and oral):

What is your current occupation/profession? *

Emergency contact:

Name *

Emergency contact

Relationship *

Emergency contact

Phone Number *

Area Code Phone Number

Email

Emergency contact

How did you hear about Freedom Through Movement? *

Please write as much or as little as you feel called to on the questions below:

NOTE: ACCEPTANCE OF APPLICATION & PAYMENT

Please note that submission of the application form does not automatically guarantee you a place in the training.

We will endeavor to notify you if your application has been successful within 1 week of submission of the online application form.

If you application is successful, payment of the deposit (US$500) must be made within 7 days upon notification for your place to be secured.

Full payment is due 10 days prior to the start of the training. Payment plans are welcome.

Why are you interested in this Unwind the Feminine immersion? What sparks your curiosity?

What are you looking to receive from the immersion?

What are you willing to give during the immersion (e.g presence, commitment, flexibility of mind etc)

Please share a talent, skill, quality or curiosity that makes you uniquely you.

Who/what inspires you?

Do you have any additional commitments that may be demanding your time and attention during the course and if so how can we best support them?

What is the biggest gift in your life at the moment?

Whatis the biggest challenge?

From your perspective, briefly describe what “Yoga” is for you and how does/can it benefit you or others? *

Do you have any physical or emotional health conditions that could affect your participation in the immersion or that we should be aware of? *

· EVENT CANCELLATION

In the unlikely event the program is cancelled by Freedom Through Movement, your payment and your deposit will be returned minus an administrative cost of US$100. Thank you for your understanding.

Travel expenditures will not be reimbursed, and are considered each individual's own liability. We strongly encourage students to purchase Travel Insurance.

AGREEMENT CHECKLIST

I have read and understood fully all the training details and information provided on the Freedom through Movement website.

I have clarified any outstanding questions I may have via email before submitting this application.

I understand that the US$500 deposit is non-refundable and non-transferable I will submit final payment by the applicable due date I will complete the pre-requisite reading and assignments I agree to commit to 100% class attendance and participation during the training I will complete any make-up homework during the training.

I will take full self-responsibility for myself, my actions and my wellbeing during the training, and will communicate any challenges or needs that may arise with the facilitators and/or assistants.

I’m ready for my idea and embodiment of Yoga to be taken to a whole new level!

AGREEMENT CHECKLIST *

I have read and understood fully all the training details and information provided on the Freedom through Movement website. I have clarified any outstanding questions I may have via email before submitting this application. I understand that the US$500 deposit is non-refundable and non-transferable I will submit final payment by the applicable due date I will complete the pre-requisite reading and assignments I agree to commit to 100% class attendance and participation during the training I will complete any make-up homework during the training. I will take full self-responsibility for myself, my actions and my wellbeing during the training, and will communicate any challenges or needs that may arise with the facilitators and/or assistants. I’m ready for my idea and embodiment of Yoga to be taken to a whole new level!

Signature *

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Local rates for Indonesian students and scholarships for those with special circumstances that prevent them from being able to pay the full price are available upon request. Please note that the spaces are limited and reserved for those with the most sincere need. Please do not ask for a discount without very good reason.

Payment

Deposit $ 500.00

Full Price $ 2,750.00

Total $ 0.00

Unwind the Feminine - Yoga Immersion 2- 24 December, 2018