Transform from Within Application

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Transform from Within Course Application

First name

Last name

Phone

Name of Emergency Contact

In order to receive the certification, I agree to attend the class sessions

I agree that my course fee will be non-refundable 60-days prior to the course start date

Due to some of the course content, it is essential to advise me of any current medical conditions, medications or mental health issues you have which may affect your participation. Do you currently have any medical, physical or mental issues you wish to disclose?

Yes

If you answered 'YES' above, please disclose any conditions which may affect your participation

Please provide your motivation for joining the course. Please write a short account of why you have decided to embark on this training. Consider including a brief description of yourself, your motivation, the flavour of your journey that brought you to this point in time and what gifts and capabilities you bring that you feel will be of interest or benefit to the course or others

How did you hear about this course

I am happy to be added to the mailing list

Please provide any questions or further comments here

Thanks for registering!