To register for the training, please fill out the registration form below.
Name*
Application Date*
Age*
Attach photo*
Address*
Zip Code & City*
Country*
Telephone*
Your Email*
Website
Education*
Former Occupation(s)*
Present Occupation*
Personal history of relevance incl. your present health. Do you have a medical history - or perhaps an addiction, we should know about? If yes, please specify. Further health information below. *
Previous experience with Grof Breathwork/Holotropic Breathwork?
Previous therapeutic/personal work experience:*
What would you like to achieve from this training?*
Anything else we should know?
How did you hear about us?*
I agree not to use any illegal substances or alcohol during the modules?* I agree