Workshop Registration Form

Please enter the information below and then click on the 'SUBMIT' button.

Workshop Dates

Octobar 29 - November 1, 2010 (Healing Breath Intensive)

November 10-14, 2010 (Advanced Meditation)
Workshop location
Ferndale, MI
First Name
Last Name
Address
City / State / Zipcode
Phone Number
Cell Phone Number
email address
Occupation
Date of birth
Sex
Ethnicity (optional)
Is an interpreter needed?
If yes, what language?
Is childcare needed?
If so, how many children will be attending?
Ages:

Course Instructor:

Drasko 'Drak' Nikodijevic
How did you hear about the course?
Briefly describe your present mental and physical health:
Please indicate if you have any
of these conditions:

Do you have a history of mental illness or under the care of a psychiatrist? Please describe:
Please describe any long-standing health problems, recent concerns or hospitalizations
Please describe in detail any
medications you are taking

Please list any meditation techniques or other self-development courses/techniques you have done:
If you have ever taught yoga, meditation, or any self-development programs, please explain:
Disclaimer

Agreement: I understand that any benefits derived from this course depend upon the extent of my participation.  I therefore accept full responsibility for the outcome and I willingly agree to follow all instructions and participate fully.  I also agree that I will not disclose the content of this course to anyone.
I further agree that I will not attempt to instruct others in any of the techniques used in the course until such time as I receive personal training from White Rabbit Resources, Inc. Refund Policy:  After the course begins no course fee is refundable.  If a participant is unable to finish the course s/he can take another course for no additional fee.  If a deposit is paid ahead of time and a participant does not start the course then all except the deposit is refundable.

 It is compulsory to attend all sessions of the course. Taking notes and
use of audio/video recorders is prohibited. 
Today's Date
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