Application form for participation in:

Online Education in Vocal Sound Therapy
with Githa Ben David

(Includes Basic education, Extra Ordinary Vessels/12 Basic Meridians)

Application form - Online Education - Vocal Sound Therapy with Githa Ben David

Name

Address

Phone

Sharing your information

Yes

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

Website address:

Applying for the following course (dates and year):

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?

Terms

I accept that participation is at my own risk

Signature

If you are human, leave this field blank.