Inspried Breath Breathwork Training Application July 12-19 2024 Tilba Tilba NSW
(confidential)
Name
First Name
Last Name
Date of Birth
Email
Address
Street Address
Street Address Line 2
City
State
Postcode
Phone Number
Please enter a valid phone number.
Emergency contact name and phone
What is your primary reason for attending?
Prior experience - have you experienced Breathwork (conscious connected breathing) or re-birthing? Please briefly describe.
Please give details of your mental, emotional and physical health (including any history of mental illness)
Drug use - are you currently, or within the past six months, have you used mind altering substances, including alcohol? If yes, please briefly detail.
Our caterer is offering a vegan (no animal products used) menu. Please advise any additional dietary requirements.
Please indicate accommodation choice.
Please Select
Shared dorm
Shared caravan
Solo caravan
Solo independent camping
Note that solo caravan option is $200 extra.
Yes, I'm in.
Should be Empty: