Breathe for Impact Registration Form

"Breathe for Impact" Registration Form

Please fill out this form carefully
Name*

VornameNachname
E-mail*
example@example.com
Mobile Number*
Birth Date

DayMonthYear
Have you done a breath journey before?

Yes, it's amazing!No, it's the first time
Do you have any of the counter-indications?*

Cardiovascular problemsAbnormally high blood pressureEpilepsy and seizuresPsychosis, Paranoia, BipolarRecent surgeryGlaucoma (eye pressure)PregnancyAsthma - please bring your inhalerI have no counter-indications
Liability Waiver
Please confirm*

I have read and do accept the liability waiver
Is there anything else that you would like me to know?
I would like to register for the following session(s):*

Thursday March 6th, 7pm - Theme: Clarity & FocusTuesday April 15th, 7pm - Theme: Grief & SurrenderTuesday May 27th, 7pm - Theme: Trust & BelongingThursday July 3rd, 7pm - Theme: Self-Love & JoyThursday Sept. 4th, 7pm - Theme: Freedom & FearThursday Dec. 4th, 7pm - Theme: tbd
Please note that if you book a session but are unable to attend, I am unable to offer a reimbursement.
Would you like me to keep you posted on future events?

Yes, please. Email or WhatsApp is fine.No thanks!
Pay here*
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Breathe for Impact - 1 Session
130.00CHF Quantity

Breathe for Impact - Full Abo (6 Sessions)15% discount
663.00CHF Quantity

Zwischensumme

0.00CHF

Steuer

0.00CHF

Gesamt

0.00CHF
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"Breathe for Impact" Registration Form