Family or group registration form - Human

This form should be completed for all human participants included in the family or group participating in the Equinox event on 20 March 2018. All info that is shared is is treated with complete confidentiality.

Q1 - Q4 require an answer, but feel free to include as much or as little info as you like for Q5 - Q9.

Send the completed form by clicking the 'Done' button at the bottom of the page when you have finished, or if you prefer to send it via e-mail, just copy and paste the form (without clicking the "Done" button) into the body of an e-mail and send it to earthhealadmin[at]gmail[dot]com

Please send us a head and shoulders pic, with your eyes showing, to: earthhealadmin[at]gmail[dot]com

Thank you for registering as a participant in the event. We will soon be in touch with you via e-mail.

* 1. Participant's personal details:

* 2. Participant's location on 20 March 2018 (nearest town/city, state, country):

* 3. Would this participant like to receive the reports and feedback sent out after the event?

* 4. Name of the person who arranged the family/group participation in this event:

* 5. Participant's three main personal focuses for this event:

* 6. Please list any health issues the participant needs help with, surgeries they have had and medications being taken:

* 7. Important periods and dates in the participant's life - include traumatic or stressful times and events, accidents, injuries, deaths, births, miscarriages or abortions, divorces, marriages, loss of job, moving home etc.:

* 8. Please list any specific problems/challenges the participant would like the treatment to focus on:

* 9. If there is any other relevant info you would like to share with us, please do so in the box below: