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? ---25-26/8/2018 - Sound Massage - Level I - Perth20-21/10/2018 - Sound Massage - Level II - Perth3-4/11/2018 - Final with Supervision - Perth5-6/11/2018 - Individual Sound Massage - Perth8-11/11/2018 - Sound Massage - Level III-IV - Perth17-18/11/2018 - Final with Supervision - Melbourne19-20/11/2018 - Individual Sound Massage - Melbourne22-23/11/2018 - Sound Massage - Level I - Melbourne24-25/11/2018 - Sound Massage - Level II - Melbourne8-9/12/2018 - Sound Massage - Level I - 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.