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? ---23-24/2/2019 - Sound Massage - Level I - Mildura VIC2-3/3/2019 - Sound Massage - Level I - Ballarat VIC3/3/2019 - KLIK1 - Margaret River WA6-7/4/2019 - Sound Massage - Level I - Margaret River WA27-28/4/2019 - Sound Massage - Level II - Margaret River WA4-5/5/2019 - Master Class - Melbourne VIC11-12/5/2019 - Sound Massage - Level I - Melbourne18-19/5/2019 - Sound Massage - Level II - Melbourne23-26/5/2019 - Sound Massage - Level 3-4 - Melbourne VIC30/5-2/6/2019 - Sound Massage - Level 3-4 - Margaret River WA25-26/5/2019 - Master Class - Perth30/5-2/6/2019 - Sound Massage - Level III and IV - Margaret River WA8-9/6/2019 - Master Class - Perth WA23/6/2019 - KLIK1 - Perth WA29-30/6/2019 - Sound Massage - Level I - Perth14-15/7/2019 - KLIK2 - Margaret River WA28-29/9/2019 - KLIK3 - Margaret River WA12-13/10/2019 - Sound Massage - Level 1 - Perth WA7-8/12/2019 - Sound Massage Level II - Perth 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]
