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* 1. Personal details

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* 2. Name & Title As You Wish It To Appear On The Certificate, if different from your full name:

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* 3. Date & Place Of Birth:

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* 4. Profession/Occupation:

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* 5. Which workshops are you attending?

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* 6. Are you a concession card holder, senior or full time student? (If yes, please bring identification to the workshop)

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* 7. Medical history: Please let us know about any CURRENT AILMENTS & MEDICATIONS, or PREVIOUS AILMENTS.

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* 8. ORGANIZATION(S) YOUR A MEMBER & PREVIOUS ENERGY WORK/TRAINING:

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* 9. Upon taking the following workshops with PADMACAHAYA International Institute for Inner Study I understand and agree to the following:

The workshops, their procedures, techniques, shown, used, discussed and/or demonstrated are for educational purposes only. No part of these workshops is presented either directly or indirectly as a diagnosis or prescription for any health problems. Persons with health problems should continue to seek appropriate professional help with qualified members of the medical profession.

I understand that my personal information will only be used for workshop purposes by Padmacahaya and will not be sold or disclosed to any other parties. Some exercises, photos, demonstrations may be recorded to assist the foundation for training purposes.

Persons using the text procedures and practices do so for educational purposes only. During the workshop I will not use, demonstrate, practice or promote any techniques not given in the Padmacahaya workshops, as they may cause confusion or misunderstanding to other workshop participants. Padmacahaya & the coordinators will not be responsible for any such activity.

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* 10. To complete your registration please deposit $50 for each workshop that you wish to attend. You can do this, either by making a Paypal deposit via the webpage, bank transfer or in person to the coordinator. The balance is payable on or before the morning of the workshop.

Please let us know when and how you made your deposit.

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