MSC Workbook Online Companion Registration

MSC Workbook Online Companion

About you:
General Data Protection Regulation (GDPR) Agreement*
- I consent to having this website store my submitted information so they can respond to my inquiry
Name*
First Last
Email address*
I identify my gender as:
Profession:
A little more about you:
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Daytime phone
Evening phone
Cell phone
To help us work with you:
Please free free to contact Kristy Arbon (kristy@heartworks.training), if you have personal concerns that you would rather discuss in person. Your information will be kept confidential.
Are there any physical or mental health concerns/conditions that we should know about or you would like to tell us about?
Have you experienced things you would consider traumatic in your life?
Are you seeing a therapist/counsellor?
Have you done any meditation before? If so what kind, and was it helpful?
How did you hear about this course?*
Please choose all that apply.
- Social Media
- Word of Mouth
- HeartWorks website
- Email notification from Kristy
Course selection and registration:
Registration Rate*
Please choose your level of registration below. Please contact Kristy (kristy@heartworks.training) if you need to discuss a different payment arrangement. I don't want finances to get in the way of you accessing this course. I will consider any offer to include you in this program.
Coupon
Payment Type*
- PayPal/Credit Card
If you are paying by check, please make the check out to:
Kristy Arbon
HeartWorks Training
PO Box 510441
St Louis, MO 63151
Total
$0.00
Comments
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