Enrolment form Name Address Date of Birth Phone number Your Email Emergency contact Please indicate which Peter Hess Sound Massage training you are registering for? ---17-18/8/2019 - Sound Massage - Level I - Melbourne22/9/2019 - KLIK1 - Margaret River WA28-29/9/2019 - KLIK2 - Margaret River WA12-13/10/2019 - Sound Massage - Level I - Perth WA14-15/10/2019 - Sound Massage-Level II - Perth WA12-15/10/2019 - Block Sound Massage - I + II - Perth23-26/11/2019 - Sound Massage-Level III-IV - Perth WA30/11-1/12/2019 - Final & Supervision - Perth WA2-3/12/2019 - Master Class-Perth WA7-8/12/2019 - Sound Massage - Level I - Margaret River WA14-15/12/2019 - KLIK3 - Margaret River WA Medical Considerations Please identify any chronic physical or emotional conditions which may impact your capacity to fully participate in this course. - I am pregnant. YesNo I am fitted with a Pace Maker. YesNo I am taking prescribed medication. YesNo I suffer from a serious mental illness. YesNo Other. YesNo Media Consent By ticking the media consent box, you agree to PHAA taking photographs or videos of you as a participant. These images may be used for promotional material (included printed, digital or online format). I agree.I do not agree. Previous Training Please list all previous training in Peter Hess Sound Massage Method and attach a copy of course certificates ——— I accept the terms and conditions of Peter Hess Academy Australia training. [recaptcha]
