Workshop Booking Form

First Name(s):

Surname(s):

Address

Telephone:

Telephone (evening):

E-mail:

Workshop required:

Venue:

Start Date:

End Date:

Duration:

Delivered by:

Do you have any questions/comments?

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Web site:

Recommendation:

Other:

1. Briefly describe your experience with the work of Louise Hay and other teachers. How has it helped you personally?
   
2. Briefly describe your experience. Are you certified or licensed in any holistic disciplines (i.e. Hypnotherapy, Aromatherapy, Reiki)?
   
3. Why do you want to take the Teacher Training Course?
   
4. Self-assessment: What are your strengths (e.g. intuitive, compassionate, creative, experience in leading groups)?
   
   How would you like to grow?
   
5. List eight (8) adjectives that describe your childhood:
   
6. Briefly describe any challenge in your life right now (e.g. health, career, relationship). How are you working with it?
   
7. Are you currently in therapy or have you been in therapy during the past five (5) years? If yes, please explain.
   

1. Name:
   
2. Gender:
   Female    Male:
3. Do you have any special dietary needs? If yes, please speficy:
   
4. Do you have any special needs or a physical challenge? If yes, please speficy: