SHAMANIC WARRIORSHIP PATH

SHAMANIC WARRIORSHIP PATH

Awakening a New Kind of Warrior Within
Dates of Workshop
Please include all dates you're attending
Warriorship Module

WhaleElephantHyenaGorillaLionDragonTigerEagleCrowBeaverDeerPraying Mantis
Name

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Birth Information

AgeBirth Date
Address

AddressCity, State & Zip Code
Phone Number
Please enter a valid phone number.
E mail
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Important Relationships...
Partner, children, pets....
Tell us a little about yourself and your interest in the Shamanic Warriroship Path....
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Educational Experience

It is helpful also for us to know a bit about your educational experience including kind & level of education, degrees, training certifcations, etc.
Kind and level of educational experience
Degrees or Certifications
Trainings
Health Information & Emergency Form

In order to adequately meet your needs, it is helpful for us to know some information about your health status. Please fill the following questions out to the best of your knowledge.

In the event of an emergency of any sort, it is our wish to provide you with support and assistance. We ask that you help us by providing the following information. This information will be kept confidential.
Recent surgeries or hospitalizations
Known allergies or sensitivities
Chronic illness
History of psychological or psychiatric treatment
Prescription medications
Name of Emergency Contact

First NameLast Name
Phone number of Emergency Contact

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Are you currently under the care of a physician or therapist and if so, please indicate their name and phone number.

Full name & relationshiopPhone number
DONATION OPTIONS AGREEMENT

Your program donation includes workshop teachings and materials. You must arrange for a place to stay and meals separately. This workshop can be attended in any combination of sessions, only one or all. A deposit of $100 is due with this application in order to reserve a space in the workshop, with the balance due at the beginning of the workshop. Payment plans are available. Please contact us to discuss.
Donation

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Aahara Spiritual Community

329 S. Douglas Ave, Springfield, IL 62704 www.aaharaspiritualcommunity.org carleymattimore@gmail.com and johnmalan@gmail.com
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