| First Name: |
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| Organization or affiliation: |
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| Please List Your Experience with Energy Medicine (Holistic Modalities) |
Holistic Modality Name
(Ex. Reiki, EFT, NLP, Hypnotherapy, Acupuncture, Yoga, Tai Chi, QiGong) |
Years
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Experience |
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| Proposed dates and time for the workshop. |
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| Potential Workshop Location (City, State, Country) |
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| Where would you host a Chinese Energetics Workshop? (Ex. Hotel, Store, Home) |
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| Select a Chinese Engergetics Workshop |
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| Approximate Number of Students(Potential Audience) |
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Provide three (2-3) topic suggestions that you would like to have addressed in this class.
(Ex. Pain Relief, Stress Relief, Fears/Phobias, Increase Body Awareness, etc..)
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What are your students needs for this workshop?
(Ex. Personal Growth, Learn Chinese Energetics for their Professional Practice) |
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| Please indicate any other area(s) of interest you may have by checking the applicable box below (select all that apply): |
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Private Sessions |
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Chinese Energetics (Books, CDs, Literature) |
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After you complete the form, you will be directed to link where you can schedule
your free 20 minute consultation.
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