Application for the 2015Body Into Being

Application for the 2015Body into Being:

Advanced Energetic Bodywork Training

with Anna Chitty, RPP, BCST, SEP, ABD and Ray Castellino, DC, RPE, RPP, RCST®

Application cost is $104 by paypal /$100 by check or cash. Application cost is in addition to / separate from the cost of the training. It is the cost for applying.

By Paypal, our ID is: . I do not take credit cards except through paypal.

By check: Send a $100 check made out to & mailed to Sandra Castellino, 1105 N Ontare Road, Santa Barbara, CA 93105. Interviews can be scheduled starting early May, 2014

Applicants will be accepted on a first come-first served basis from those who complete the application process. Most of you will have a 15 min skypeor phone interview with Anna and Ray after the application is received. Responses will be given after application, picture, payment and interview are complete.

Please fill in your form using bold for the answers, leaving the questions in regular font. Send along with a digital picture of yourself to all 3 emails:

Name and any academic or credentials after your name:

Address:

City, State, Zip:

Home Phone: Bus. Phone Cell Phone:

Fax:

Email:

Website:

Skype address

Age and Date of Birth:

What is your goal in taking this training including how you plan to use it?

Training in bodywork, health education and related fields:

Current occupation & years experience in bodywork / healthcare practice:

Describe your professional bodywork / healthcare practice during the last 5 years. Specify minimum-maximum #clients/week, workshops taught, modalities used.

Give this information about your practice 5 years ago as well as 2014, letting us know about any changes in modalities, #clients seen, teaching, etc.

Describe your health condition & recent medical history, including any current medications for physical and/or mental health:

Are you able to commit to all 5 days of all 5 modules?

Are you willing to abstain from alcohol from the day before the start of each module through the end of each module?

Is your lifestyle nicotine and recreational drug free and can you commit to remaining that way for the year and 3/4 from now through the end of the training?

Are their any challenges for you to taking the training?

Applicants will likely be asked to do a 15 min max Skype interview with Anna and Ray

I am available for an interview by skype (give skype name ______)

and phone (give phone number______)

Please give both if you have both.

Once all the parts of your application are received, Sandra will set up an interview time with Anna/Ray. That is this form, a picture and $100 payment received.

Indicate how your are paying the deposit: check, credit card, paypal or other.

And when you have sent the check, paypal, etc.