Open Heart Level 3 & 4 • December 6 & 7, 2025

(Online) Upgraded Open Heart Level 3 & 4

Sally Mydlowec • December 6 & 7, 2025 • 8am - 4pm LA Timezone
Participant's Full Name (to be printed on the certificate)*
Email & Reconfirm Email*

Confirmation EmailEach participant should have his/her own unique email address. Ensure spelling is correct as important communication will be sent to the email provided above. From our experience, Zoom links are easily received by Gmail accounts.
Cell Phone*

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Full Name of Emergency Contact*
Relationship to You (Parent, Spouse/Partner, Sibling,Friend, Other)*
Phone Number of Emergency Contact*

Country CodeWhatsApp Number
Alternative Phone Number of Emergency Contact (if available)

Country CodePhone Number
Email Address of Emergency Contact (if available)
Preferred Language (if not English) of Emergency Contact
To facilitate communication, you may be added into a Whatsapp group with other participants from the same workshop*

Yes, I give my consentNo, I do not consent. I’m aware that by not consenting, I may miss out on important communication related to the workshop
Where you will be participating from?*

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Postal / Zip CodeCountry
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I am Indonesia CitizenI am a KITAS/KITAP holderI am non KITAS/KITAP (tourist)
Payment option*

Bank Transfer to Local bank Account in local currencyPayPal (except for Australia, Indonesia, Malaysia and Singapore)
Are you 18 years old and above on the date of the event you registered for?*

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All minor participants/below 18 years old must submit a Consent & Authorization for Minor signed form. Please download it from: http://bit.ly/NWLMF and upload it here or send to XXXX (email of Coordinator)
Parents/Legal Guardian of Minor Participant's Full Name*

PRIVACY AND TERMS OF SERVICE

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Please find below:

    I. Natural Way of Living Participant Code of Conduct

   II. Statement of Waiver and Release of Liability

III. Undertaking of Confidentiality and Non-Disclosure (“Undertaking”)

IV. Cancellation & Refund Policies

   V. Privacy Policy

Please make sure that you read and understand the statements and kindly tick the box
Full Name of Participant (or Parent/ Legal Guardian of Minor)*
Date*

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I hereby give consent for the Privacy Policy to apply to my current and previous data collected through this website/service prior to the passage of the General Data Protection Regulation into law in the European Union*

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I hereby give consent for Natural Way of Living and/or affiliated parties to send me information relating to Natural Way of Living’s products, services and activities (you can unsubscribe at any time). I am aware that if I do not agree, Natural Way of Living will cease all communication and I consent to forego my right to receive relevant information for this workshop.*

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I confirm that all the information given in this form is true and accurate
After clicking submit, you should receive an auto-reply from Jotform within several minutes to the email address you registered, this indicates a successful submission.
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(Online) Upgraded Open Heart Level 3 & 4

WORKSHOP REGISTRATION

PRIVACY AND TERMS OF SERVICE