EMHA FREE Foundation Weekend Online 2023 Application

FREE Foundation Weekend Application, Saturday 21st and Sunday 22nd January 2023

Complete the form below to APPLY for your FREE PLACE.
NAME: *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
MOBILE NUMBER: *
please include international code
ARE YOU AVAILABLE ON WHATSAPP WITH THIS NUMBER? *

Yes No
E-MAIL ADDRESS: *

Confirmation Email
AGE: *
CURRENT OCCUPATION: *
NATIONALITY: *
DO YOU SPEAK AND READ FLUENT ENGLISH? *

YES NO
HOW DID YOU HEAR ABOUT EVOLVE MINDS? *
HAVE YOU TRAINED IN HYPNOTHERAPY BEFORE? *

YES NO
DO YOU HAVE ANY MENTAL HEALTH ISSUES THAT YOU ARE CURRENTLY AWARE OF? *

YES NO
PLEASE TELL US WHY YOU WOULD LIKE TO BE CONSIDERED FOR A FREE PLACE: *
ARE YOU AVAILABLE TO JOIN US FOR THE WHOLE WEEKEND, SATURDAY 21st & SUNDAY 22nd January 2023 *

YES NO
Should be Empty:

FREE Foundation Weekend Application, Saturday 21st and Sunday 22nd January 2023