Returning Student Bodywork Registration Form

Returning Student Rosen Method Bodywork Registration Form

Your answers to the registration form questions are confidential and will only be seen by teachers and staff.

Name

First Name

Last Name

For which bodywork intensive/workshop are you registering?

Email

Phone

(###)

###

####

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of birth

MM

DD

YYYY

Name of emergency contact

First Name

Last Name

Emergency contact's relationship to you

Emergency contact's phone number

(###)

###

####

Have there been any significant changes for you since the intensive?

If yes, please describe the changes - physically, mentally, emotionally, spiritually?

Please evaluate your present emotional state.

Please sign and date this registration form.

Your signature confirms that you have filled out this form accurately and honestly, and that you have referred to the RMOC website for our cancellation/refund policy.

Date of signature

MM

DD

YYYY

Please refer to the RMOC website for our cancellation/refund policy.

Attendance is required from the beginning to the end of the intensive.