Name * First Name Last Name DOB MM DD YYYY Gender Male Female Non defined Prefer not to say Ethnicity (how you regard yourself). Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Email How did you hear about this course? Have you done any other training with us? Special learning requirements Please inform us of any special learning requirements you have so we can adapt the course delivery to suite your needs the best we can. None English as second language Dyslexia Audio impairment Visual impairment Physical impairment Other If you have clicked other please give us more details here. Have you any experience of Body Therapy, either as a receiver (client) or as therapist? Please describe your experience (if it’s zero, that’s fine!) Please tell us a little bit about your purpose in doing this course. It doesn’t have to be a Grand Plan - just an idea of what your aims might be. Please Check your preferred location of study Nelson Christchurch Elsewhere (courses can be delivered elsewhere to a minimum of 6 people). OIf you clicked elsewhere, please state the area you would like the course to be delivered. Thank you! Once you have been assigned a tutor, you will be contacted about booking and deposit requirements. We look forward to working with you soon. Holistic Pulsing Expression of Interest form Once you are assigned a tutor, you will be contacted about your booking and deposit requirements.
