Clone of 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
Did you already sign this waiver in a previous session?*

YesNo
Date
Please sign

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Is there anything else that you would like me to know?
I would like to register for the following session(s):*

Thursday, 5 March, 7pm - Theme: Clarity & Inner KnowingThursday, 9 April, 7pm - Theme: Freedom & FearThursday, 2 July, 7pm - Theme: Trust & BelongingThursday 17 September, 7pm - Theme: Grief & SurrenderThursday 3 December, 7pm - Theme: Interbeing & Self-Love
Please note that sessions are not transferable. 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.No thanks!
Pay here*
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Breathe for Impact - 1 Session
145.00CHF Quantity

Breathe for Impact - Full Abo (5 Sessions)15% discount
616.00CHF Quantity

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0.00CHF

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"Breathe for Impact" Registration Form