Applicaton form for the International Education in Vocal Soundtherapy

Name

Address

Phone

Email

Sharing your information

Yes

No

Can we share the information above with the other attendees from the course you'll participate in.

Course

Which course would you like to participate in?

Did you previously attend any course with Githa? If yes, please state them here.

Age

Occupation

Education / Background

Motivation to participate in the course

State of health

Do you use any medication?

Are you addicted to any kind of drugs or alcohol?

Do you suffer from mental illness/anxiety?

Do you have artificial parts in your body? If yes, where?

Is there anything your body can't tolerate?

Do you want vegan or vegetarian food?

Do you suffer from a lactose, gluten or peanut allergy?

Do you want shared transport to the course location? If yes, mention from where.

Do you snore a lot or suffer from sleep apnea?

No

Yes

Do you want a private room if possible?

Yes

No

Do you want a particular roommate?

Suggest dates and times for a short conversation via phone or Skype.

Date

Time

Terms

I accept that participation is at my own risk

Signature