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? ---8-9/12/2018 - Sound Massage - Level I - Margaret River WA3/3/2019 - KLIK1 - Margaret River WA9-10/3/2019 - Sound Massage - Level I - Margaret River WA5/4/2019 - KLIK1 - Perth WA6-7/4/2019 - Sound Massage - Level I - Perth WA27-28/4/2019 - Sound Massage - Level II - Perth WA11-12/5/2019 - Sound Massage - Level I - Melbourne18-19/5/2019 - Sound Massage - Level II - Melbourne25-26/5/2019 - Master Class - Perth30/5-2/6/2019 - Sound Massage - Level III and IV - Margaret River WA28/6/2019 - KLIK1 - Perth WA29-30/6/2019 - Sound Massage - Level I - Perth27-28/7/2019 - KLIK2 - Perth WA19-20/10/2019 - Sound Massage - Level 1 - Perth WA7-8/12/2019 - Sound Massage Level 1 - 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.