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Jari Menari Massages Description

Form Application

"Please answer all questions listed below in English"
Please fill out all the information below
譌・譛ャ隱樒筏霎シ譖ク縺ッ繝励Μ繝ウ繝医い繧ヲ繝医@縺ヲ縲√ヵ繧。繝�け繧ケ縺ォ縺ヲ縺企√j縺上□縺輔>縲
繝輔ぃ繝�け繧ケ逡ェ蜿キ62-361-736 740
My Information
Name:
E-mail Address:
Phone number:
Height:
Weight:
Sex:
Do you have any physical limitations
that we need to know about?

Do you have allergies or food restriction
that we need to know about?

Have you had any illness or surgery
in the last year ?
Yes No
If yes, please explain :
 
 

Hotel Information
Name:
Address:
Phone number:

Questions to Answers
1.
Do you need a translator No Yes
2.
Language needed if you need translator
(additional charge will apply)
3.
I am taking this class for : Personal growth Professional growth
4.
I am a massage practitioner and
  have a private massage practice
  work in spa
  teach massage
5.
I have studied: Please mark each modality and write in other areas of study
Thai Massage for (weeks/months/years)
Aromatherapy Massage for (weeks/months/years)
Shiatsu Massage for (weeks/months/years)
Deep Tissue Massage for (weeks/months/years)
Cranial Sacral Work for (weeks/months/years)
Reiki for (weeks/months/years)
Yoga for (weeks/months/years)
Dance for (weeks/months/years)
Movement Practice for (weeks/months/years)
Other (Please list)
  for weeks/months/years
 

I want to Register for workshop:
 
Massage Appreciation Classes - Exploring Basic Massage - 1 Day Class
Half Day Introductory Courses includes: Yoga, 3-hrs Class, Lunch and 90-min Massage
 
Massage Appreciation Classes - 2nd Day Class (optional)
Wednesday following tuesday class
 
Jari Menari Sequence Massage - 12-days of Class over 2 weeks
April 9-26, 2012
 
Basic Touch Techniques Private Classes
Desired Date for workshop: First choice:
Second choice:
Time :
morning
afternoon
 
Enhancing Your Delivery: Custom Designed Workshop for Massage Practitioners
Desired Date for workshop: First choice:
Second choice:
Time :
morning
afternoon
   
Number of Students :

Additional Information:

I will stay in Bali for :
days
 
 
   
   
 
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