Adventures in Awareness(TM): AIA Journey Ride Registration

You have selected:

AIA Journey Ride (What's this?)
May 7 - 9, 2010
EquuSatori Center
Sebastopol, California
Tuition: $1050.00
Deposit: $650.00

Step 2. Registration Information

Name (First & Last):

Address:

City:

State:

Zip:

Website:

Phone: (Include area code)

Cell:

Email:

Country:

Date of Birth:

Age:

Height:

Weight:

Any sensory or mobility issues, allergies, special needs?

I am pregnant, or possibly pregnant:
Yes
No

Eating Preferences:

Vegetarian:
Yes
No

Considerations:

Sensitivies:

Lodgings while attending:

Life Changing Circumstances:
Marriage
Divorce
Death of a loved one
Career re-frames
Geographic re-location
Health challenges
New status as grandparent

While horse experience is not essential, briefly describe your horse background:

I identify as:
Horse Professional
Animal handler
Health Professional
Program Director
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 experiential learning. I am aware that this equine facilitated experiential learning process evokes feelings and emotions.

Group Attendance
I am partipating as a member of a group from:

The other person/people in my group attending the AIA Journey Ride is/are:
1. Person Name:

2. Person Name:

3. Person Name:

4. Person Name:

When I return home, my support system is:
12 Step Program
Feelings Support Group
Individual/group therapy
Church group
Spiritual Practice group

Other (please specify):

AIA workshop(s) I have attended:
(give approximate date and location).

Adventures in Awareness(TM)
info@adventuresinawareness.net
520.247.3383