Intro to Mindful Somatic Ecotherapy
Fill out the form carefully for registration
Participant Name
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First Name
Middle Name
Last Name
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
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example@example.com
Mobile Number
Please check which city you are wanting to attend the intro in
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Wellington
Dunedin
Please share with us your comfort and experience in nature
*
Please share any previous experience either counselling, adventure therapy etc.. where you have supported people in a therapeutic role.
Please share any significant medical conditions and that will restrict you walking on nature trails or being alone in nature. The Maximum distance required to walk is 200m
Do you have any allergies to bees, pollen or any other aspects of nature that will compromise your well being or safety that would be helpful for us to know.
Is there anything else you would like us to know?
Emergency Contact Person
Emergency Person Contact Phone No
We have a 1 month cancellation policy. If registration is cancelled less than 1 month prior to the event we will not be providing a refund. If cancelled prior to 1 month or the event is cancelled by the organisor 100% refund will be provided. Please reply yes in the space below to acknowledge that you have read this.
I acknowledge that until payment is made this registration process is not complete
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