ADVENTURES IN AWARENESS(TM) WORKSHOP APPLICATION 9852 E. Skyview Drive Tucson, AZ 85748 please fill in all the blanks Name:________________________________________________________________________ Address:_____________________________________________________________________ City:_______________________________ State:__________________ Zip:__________ Country:_______________________________ Phone:_____________________ Cell:________________________ E-mail:____________________ Website:_____________________________________________________________________ Date of Birth:___________________________ Age:______________________________ Height & Weight:____________________________________________________________ Eating Plan:____________ Vegetarian?_____ Considerations? Sensitivities?___________ Name of Workshop attending – Date & Place:________________________________ Lodgings while attending:____________________________________________________ Brief summary of current life situation:_____________________________________ Are you pregnant?_____________ Life changing circumstances: marriage, divorce, death of a loved one, career re-frames, geographic re-location, health challenges, new status as grandparent, include any sensory or mobility issues, allergies, special needs? While horse experience is not essential, briefly describe your horse background.___________________________________________________________________ ______________________________________________________________________________ I identify as: Horse Professional_____Animal handler____ Health Professional____Program Administrator_____ Educator:____ Student:____ Interested in Stress Skills ____ Other: (please specify) I am aware that this is an “experiential workshop” – learning through doing. I know I will be discovering more about myself as I learn to work with horses as colleagues in equine guided education. I am aware that equine facilitated experiential learning process work evokes feelings and emotions and is a personal growth experience. When I return home, my support system is: 12 Step Program______ Feelings Support______ Group______ Individual/group______ Church group______. Spiritual practices group______ Other______. Signature__________________________________________________Date______________ Make $600 deposit check out payable to AIA and send to: AIA c/o Barbara K. Rector, 9852 E. Skyview Drive, Tucson, AZ 85748 USA Workshop deposits are non refundable and do apply to another AIA workshop.