ENERGY THERAPIES INSTITUTE

Practitioner Training
in the U.S.A. and AUSTRALIA.

Enrollment Form

Pics of Therapies at ETI



Please provide the following enrollment information in full and submit it by the cut-off date. Responses are required to all questions except where indicated as “optional”.

Provide the information in the body of an email to Energy Therapies Institute OR download the PDF Enrolment Form and snailmail a completed hard copy to PO Box, 971, Stephens City, VA 22655, USA. Choose this option if you are not comfortable emailing your enrollment. Participants in the USA can send their fees check at the same time if they choose to submit a hard copy enrollment form, or pay by credit card. Participants in Australia, please follow the payment guidelines online.

All information submitted is kept confidential by Energy Therapies Institute except for legal exclusions or requirements specified by the Privacy Acts of the relevant jurisdictions. CLICK HERE for additional info about Enrollment Procedures

COURSE (Its name & level)

COURSE/ MODULE DATE & LOCATION

YOUR NAME AND...

ADDRESS

PHONE - Please provide at least one number where you can be reached.

Home

Work

Mobile

EMAIL

WEBSITE/S

QUALIFICATIONS

EMERGENCY CONTACT AND NUMBER - i.e. who do we contact in the event of an emergency affecting you during training?

REASONS FOR WISHING TO UNDERTAKE THIS TRAINING. What do you hope to achieve from this course?

PRIOR STUDY OR EXPERIENCE IN ALTERNATIVE HEALTH THERAPIES OF HEALTH CARE. What, if any, courses have you taken in Alternative Health Therapies?

PRIOR MOVEMENT EXPERIENCE (e.g. Tai Chi, Yoga, Pilates, Dance etc. Please specify type - e.g. "Hatha Yoga"; "Ching Chun Tai Chi".)

IS THERE ANYTHING THAT COULD AFFECT YOUR PARTICIPATION IN THE LEARNING PROGRAMME YOU HAVE SELECTED, INCLUDING ANY MEDICAL CONDITIONS? PLEASE SPECIFY.

HAVE YOU EXPERIENCED ACCIDENT/S, TRAUMA, and/ or SURGERIES?

DO YOU HAVE A SPIRITUAL PRACTICE (Optional. This question is asked because having a meditation or spiritual practice is an important resource for Energy Therapy Practitioners.)

DESCRIBE ANY PERSONAL GROWTH EXPERIENCE OR TRAINING THAT YOU HAVE HAD, e.g. seeing a therapist/ psychologist/ counsellor; personal growth or psychological workshops/ training; attending personal growth retreats or centers etc. (This type of experience or training can be very helpful in working as a Practitioner.)

HAVE YOU EVER BEEN OR ARE YOU CURRENTLY UNDER THE CARE OF A PSYCHOLOGIST OR PSYCHIATRIST? Please specify.

HAVE YOU EVER OR ARE YOU CURRENTLY TAKING PRESCRIPTION ANTI-DEPRESSANTS, PSYCHOTROPIC MEDICATIONS OR SIMILAR? Please specify.

HAVE YOU EVER BEEN TREATED FOR SUBSTANCE ABUSE - e.g. alcohol, recreational drugs, street drugs?

HAVE YOU EVER BEEN CONVICTED OF A FELONY?

DO YOU HAVE ANY DIETARY RESTRICTIONS?

HOW DID YOU HEAR ABOUT ENERGY THERAPIES INSTITUTE?

HELP US TO GET TO KNOW YOU: IS THERE ANYTHING ELSE YOU WOULD LIKE TO TELL US ABOUT YOURSELF? (Optional.)

CONTACT

Company & Site Info

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