Switzerland in-person workshop only registration form

Your name

Your date of birth

Phone Number

Email Address

Address

Occupation

Would you like to add another participant to attend the workshop? Would you like to add another participant to attend the workshop? Add another Participant

Participant 2 name

Participant 2 date of birth

Participant 2 Phone Number

Participant 2 Email Address

Participant 2 Address

Participant 2 Occupation

Would you like to add another participant to attend the workshop? Would you like to add another participant to attend the workshop? Add another Participant

Participant 3 name

Participant 3 date of birth

Participant 3 Phone Number

Participant 3 Email Address

Participant 3 Address

Participant 3 Occupation

Would you like to add another participant to attend the workshop? Would you like to add another participant to attend the workshop? Add another Participant

Participant 4 name

Participant 4 date of birth

Participant 4 Phone Number

Participant 4 Email Address

Participant 4 Address

Participant 4 Occupation

Would you like to add another participant to attend the workshop? Would you like to add another participant to attend the workshop? Add another Participant

Participant 5 name

Participant 5 date of birth

Participant 5 Phone Number

Participant 5 Email Address

Participant 5 Address

Participant 5 Occupation

Referred by

What are your professional interests?

What do you hope learn during the workshop?

How did you find out about our workshop?

Please read and check the boxes next to the following agreements: Please read and check the boxes next to the following agreements: I understand that the lessons given by the Feldenkrais®/ABM® NeuroMovement Practitioner (hereafter the “Practitioner”), are a way to open doors to new possibilities of movement and development, and are educational only. They are not medical and do not take the place of appropriate medical care. I agree to let the Practitioner know immediately if I experience any discomfort or pain. I affirm that I will notify the Practitioner of all of my known medical conditions and injuries and will inform him/her of any changes in my health and medical condition.

Participant 1 - print your name

Date

Participant 2 - print your name

Date

Participant 3 - print your name

Date

Participant 4 - print your name

Date

Participant 5 - print your name

Date