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We're Hot!
日本語インフォメーション
 
 
 
 
"Please answer all questions listed below in English"
Please fill out all the information below
My Information
Name:
E-mail Address:
Phone number:
Height:
Weight:
Sex:
Do you have any physical limitations
that we need to know about?

Do you have allergies or food restriction
that we need to know about?

Have you had any illness or surgery
in the last year ?
Yes No
If yes, please explain :
 
 

Hotel Information
Name:
Address:
Phone number:

Questions to Answers
1.
Do you need a translator No Yes
2.
Language needed if you need translator
(additional charge will apply)
3.
I am taking this class for : Personal growth Professional growth
4.
I am a massage practitioner and
  have a private massage practice
  work in spa
  teach massage
5.
I have studied: Please mark each modality and write in other areas of study
Thai Massage for (weeks/months/years)
Aromatherapy Massage for (weeks/months/years)
Shiatsu Massage for (weeks/months/years)
Deep Tissue Massage for (weeks/months/years)
Cranial Sacral Work for (weeks/months/years)
Reiki for (weeks/months/years)
Yoga for (weeks/months/years)
Dance for (weeks/months/years)
Movement Practice for (weeks/months/years)
Other (Please list)
  for weeks/months/years
 

I want to Register for workshop:
 
Learn Massage : A One Day Class
Half Day Introductory Courses includes: Yoga, 3-hrs Class, Lunch and 90-min Massage
 
Learn Massage : A One Day Class - 2nd Day Class (optional)
Wednesday following tuesday class
 
Jari Menari Sequence Massage - 12-days of Class over 2 weeks
Enrollment form for 2015, Date to be determined
April 9-26, 2012
 
 
   
Number of Students :

Additional Information:

I will stay in Bali for :
days