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* 1. Please enter:
  1. First name
  2. Last name
  3. Address 1
  4. City
  5. State
  6. Zip
  7. Phone
  8. Email
  9. Emergency contact/s

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* 2. What is your current experience with yoga, meditation, or other movement and mindfulness practices?

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* 3. What is your desired experience with yoga, meditation, or other movement and mindfulness practices in the future?

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* 4. What interests you about Balance Through Movement?

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* 5. Do you have a specific intention for registering for this training?

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* 6. What is an area of your life that you would like to create change in? How will this training support that?

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* 7. Are there any elements of the program that might pose a challenge to you either emotionally or physically? Please explain.

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* 8. Joining an intensive training such as this can be a rewarding, and challenging experience at times. Do you currently see a therapist?

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* 9. What is your current occupation or course of study?

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* 10. Please share anything additional that you would like to share, or any questions or special considerations that you might have.

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