JDHB Registration Form 2024 OCT

Jubilee Double Holotropic Breathwork™ Workshop

October 31 - November 3, 2024; Dobogókő, Hungary
Name*

TitleLast NameFirst Name
Occupation
Address*

Street Address

CityState / Province

Postal / Zip CodeCountry
Address for invoice (in accordance with the tax law we can only issue an invoice to the owner of the bank account from which the transfer occurs)

Company name

Street Address

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Country CodeArea CodePhone Number
Email*
example@example.com
How did you get to know about this workshop? More than one answers may be chosen, if appropriate.*

I have already participated in a Holotropic Hungary workshopholotropic.hu websiteOther websiteE-mail newsletterFacebook post/sharePublic event (lecture, workshop)Personal recommendation from someone who has done Holotropic Breathwork beforeTherapist, facilitator:Who?

Privacy notice and consent

Information collected in the forms serves the purpose of communication, invoicing and to evaluate the safety of participation in the Holotropic Breathwork™ workshop. We handle personally identifyable information confidentially, complying with the General Data Protection Regulation (GDPR, 2016/679) of the European Parliament. We do not pass the information on to third parties.

Data managers: Balázs Rákóczi and Csaba Sőti

Contact: holotropic.hungary@gmail.com

Beyond data managers only certified GTT facilitators of the workshop are granted access to the information, who are bound by the confidentiality and ethical agreements of Grof Transpersonal Training (similar to the ethics of medical and psychological professionals). Data indicated on invoices are accessible by the accountant professionals according to the accounting law. Regarding the security of information sent via email (gmail, yahoo, etc.) we refer to the privacy policy of the respective email provider(s). Data records – unless subjected to legal regulation – are maintained till the purpose of data handling is completed or until authorization is withdrawn. The person providing information has the right to request the access to his or her personal data, the correction of the personal data, the deletion of the personal data and the restriction of the personal data. Further, the person can protest against the management of the personal data, has the right to the data portability and to submit a complaint to the supervisory authority. Right to correction or deletion of personal information does not apply to data that are mandatory to preserve due to either administrative, legal or security reasons.
Please read and confirm the following statement*

YES, I consent to the collection and use of my personal information. I understand that some of my data beyond the data managers will be accessible by GTT facilitators working on this Holotropic Breathwork™ workshop and by the accountants. I understand that my personal data sent via email are subject to the privacy policy of the relevant email provider(s). I declare that I have informed my "Emergency Contact" person and (s)he has consented to provide his/her name and telephone number. I declare that I have been informed about the purpose of data management and about my rights, that I have understood and contributed my data management consent voluntarily to the aim of the data management purpose.
Travelling during COVID 19

We ask participants who are coming from outside of Hungary that please gather information about the travel restrictions from either this link or from the Hungarian embassy in your country.
Note

This is an encrypted registration form, which will be stored in a secure server. We will send no data by email. If you want to save (or need the banking information), please, before Sumbission choose Print Form and save the form in pdf format or copy the information relevant for you.
Beginning from the dot draw along the line of the shape*
Should be Empty:

	YES	NO
Cardiovascular disease, including heart attacks, cardiovascular surgery or any cardiovascular symptoms such as angina or arrhythmia
High blood pressure
Strokes,TIAs, seizures, or other brain or neurological conditions
Diagnosed psychiatric condition
Recent surgery
Past or recent physical injuries, including fractures or dislocations
Present or current infectious or communicable diseases
Fever, cold-like symptoms, coughing in the last 2 weeks
Glaucoma
Retinal detachment
Epilepsy
Osteoporosis
Cancer, leukemia, malignant disease
Asthma (if yes, please bring your inhaler to the workshop)

	YES	NO
Are you currently pregnant?
Have you been hospitalized in the past 20 years for significant medical issues?
Have you ever been psychiatrically hospitalized?
Are you currently in therapy or involved in any type of support group?
Are you currently taking any type of medication? (if yes, please list)
Is there anything else about your physical or emotional status we should be aware of?
Have you attended a GTT Holotropic Breathwork workshop before?

Jubilee Double Holotropic Breathwork™ Workshop