Registration Name * First Name Last Name I am registering for: * Somatic Dance Training Portugal Level 1 Somatic Dance Training Bali Level 1 Somatic Dance Training NZ Level 2 Somatic Dance Training NZ Level 3 Email * Phone * (###) ### #### Instagram Handle (to contact you if we need) Date of Birth MM DD YYYY Have you attended a training with us before? Yes No Please tell us about your previous trainings Do you have other movement experience? Do you have a regular meditation practice? If yes, tell us more What brought you to this particular training and what are you hoping to gain? If you are already a teacher, what do you consider your greatest strengths as a teacher/ facilitator? What areas of teaching do you wish to improve? How many years have you had a movement practice? Are you taking any medications? Do you have any current or recent injuries? Yes No If yes, please tell us more Do you suffer from mental health, anxiety, depression or trauma? ( It is important that we are fully informed of such challenges prior to the training.) Yes No If yes, please be thorough and list in detail Accommodation Preferences (THAILAND & BALI TRAINING ONLY) Do you have any preferences for your accommodation? Sharing a room with mixed gender, same gender, coming with anyone you know? Bali & Thailand Only: What room/accommodation are you desiring to book? The Taj Dorm (4 person room) Gladak Twins (2 person room) Taj Delux Twin (2 person room) Little Sweet (Solo room) Do you have any dietary requirements? Is there anything else we should know? How did you hear about this training? Thank you!