First-time Registration To be completed by Participants only. REGISTRATION QUESTIONNAIRE Please fill in your name: Invalid Input Invalid Input Please fill in your email: Invalid Input Can I add you to my mailing list for future events? Yes Invalid Input Profession/Occupation: Invalid Input Please fill in your address: Invalid Input Invalid Input Invalid Input Invalid Input Invalid Input Please fill in your phone number: Invalid Input Emergency Contact Name and Number: Invalid Input Date of Birth: Invalid Input Referred by: FriendInstagramClubhouseFacebookWeb searchEmailEmpathic.HealthOther Invalid Input If other, please share details: Invalid Input Have you participated in breathwork before?: Invalid Input What brings you to want to engage in this process now?: Invalid Input Have you done other types of expanded states of awareness/non-ordinary consciousness work? What kinds?: Invalid Input Are you currently in therapy or any other support groups?: Invalid Input What do you do to support your personal and psychospiritual health and growth?: Invalid Input Do you have an questions or concerns about participating in this work? Invalid Input Invalid Input Submit Next
