Exit this survey Certified Laughter Yoga Leader Training 1. Default Section Question Title * 1. Please complete the fields below with the exact information you wish to be submitted to Dr. Kataria's School of Laughter Yoga. Name: * Company: Address: * Address 2: City/Town: * State: * -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code: * Email Address: * Phone Number: * Question Title * 2. Do you have a personal or professional web site that you wish to share? This is optional. Question Title * 3. Please tell me a little about your work history. Do you work full time or part time? What industries do you currently or have you previously worked in? Are you a stay-at-home-parent? Question Title * 4. How did you first hear about the global Laughter Yoga movement? "Laughing Club of India" Documentary BBC "The Human Face" with John Cleese YouTube Dancing with the Stars Oprah Portland Laughter Yoga Other (please specify) Question Title * 5. How did you hear about this particular Certified Laughter Yoga Leader Training? LaughterYoga.org Listing Portland Laughter Yoga Craig's List Willamette Week's BackPage Classifieds FaceBook Flier Other (please specify) Question Title * 6. Why do you want to become a Laughter Yoga Leader? For my own personal stress relief & joy To share with friends & family To share with the general public To start a business To enhance my current business & professional offerings Feel free to elaborate! The more I know, the more I can tailor the training to meet your needs! Question Title * 7. Please select all that apply. I am interested in learning about Laughter Yoga specifically: with Children with Seniors with Corporations & Organizations with Non-Profits to begin a free Laughter Club to offer paid Classes & Workshops to create a complete business around Laughter Yoga to integrate into an existing profession or business Question Title * 8. Part of the training will encompass practicing public speaking. Nothing major! But there are some basic ideas around Laughter Yoga that each leader needs to memorize. Since I know the most common fear is public speaking, please let me know your experience and comfort level. This will allow me to gauge how much time we might need to spend on this piece. Please note that your experience & comfort level may not be the same & that is okay! Zero - Terrified! Minimal - Not enjoyable Decent amount - Not to shabby Experienced - Love it! Speaking Experience Speaking Experience Zero - Terrified! Speaking Experience Minimal - Not enjoyable Speaking Experience Decent amount - Not to shabby Speaking Experience Experienced - Love it! Speaking Comfort Level Speaking Comfort Level Zero - Terrified! Speaking Comfort Level Minimal - Not enjoyable Speaking Comfort Level Decent amount - Not to shabby Speaking Comfort Level Experienced - Love it! Comments Question Title * 9. Do you have any conditions, disabilities or allergies that I should be aware of during the training? Yes No If "yes" please specify: Question Title * 10. Is there anything else that you wish to share with me before the training? Is there anything specific that you want to ensure that I cover during training? Questions or comments are welcome! Next