Registration form and contract for the workshop

Trauma & Spirituality

June 27-29, 2018

Data workshop (3 days):
2018, June 27-29 / Location:
De Reehorst,
Bennekomseweg 24
6717 LM Ede / Lecturer:
Peter Levine
and
Marianne Bentzen / Workshop price:
€ 695,-excluding accommodation (see below)

General student data:

Full name(s) / Date of birth
emailadress / Phone number
Full adress / How did you become aware of Bodymind Opleidingen?
Billing address
(only if different from above):
Are there any medical (physical or mental) conditions the staff should be aware of?
In case of unexpected emergencies, who should be alerted? (name(s) and telephone numbers)

Please remember to fill out date, place and name on the last page of this form!

Payment Workshop fee: (please tick [x] for agreeing the conditions)

I subscribe and pay the full workshop fee before May 1st of 2018.
I will pay after invoice date an advance payment of € 250 and do the remnant of € 445 before May 1st of 2018.
In contrast to the general conditions of Bodymind Opleidingen, this advance payment is nonrefundable.

Payment Accommodation:

Various options are possible. You will have to book yourself with ‘De Reehorst’.

This is possible 1,5 month before the module starts, you will get a mail from the officemanagement of Bodymind Opleidingen.with a link which you can use to book your accommodation.

Required: base cost accommodation including lunch, coffee and tea for 3 days appr.€ 105,-

To give you an example of options:

-Full Board including lunch, coffee/tea, dinner, breakfast and overnight stay based on single room, with shower/toilet. Appr€ 365

-Day arrangement for 3 days including lunch, coffee/tea appr €105,-

-Live Cooking Dinner Valentino including 2 consumptions appr€30,-

Background student:

The questions below are intended to provide a broad picture of your professional background and motivation. This information will of course be treated confidentially and only be accessible by the teachers and assistants.

I. Professional practice and background

a. Please fill in the information about your professional background.(if you have followed any more courses, you can copy & paste the table below.)

Name of the (relevant) training or institute / When did you study here?
Number of years or days that the training lasts / Certificate obtained?
Website location / Location of the training
Any comments

b. fill in the data in your current professional practice

Working as / How many hours a week?
Number of years / Organisation where you work (If applicable)
Website location / location
Any comments

II. Motivation

1.What is your motivation for attending this workshop?
2.Do you have experience in the field of trauma work and/or body-oriented psychotherapy?
3. If you have any questions or comments for us, you can write down below.

Declaration, contract and date

The student/learner declares, as far as he/she knows, to be in good physical and mental health and to disclose any limitations. The student/learner remains under all circumstances responsible for her/his physical and mental health.If something changes relating to the physical and/or mental health of the student, he/she will immediately inform a staff member of Bodymind.

The student/learner remains at all times responsible for his personal belongings such as clothing, footwear, jewelry etc.

Within 14 days after the invoice date, an advance and nonrefundablepayment of € 250,- should be transferred. The rest of the workshop fee must be paid at last at May 1st 2018.

After sending this application form there is a period of seven days during which the student can change his/her mind and withdraw the application. After this deadline, the general conditions of Bodymind Opleidingen, and the financial obligations set forth in them, form a contract between Bodymind Opleidingen and the student.With the exception that the advance payment for this workshop is non-refundable.

Complaints regarding the workshop, theworkshop material or the teacher(s) may be primarily reported to the Office of Bodymind Opleidingen. There will be a serious attempt to a find possible solution. If no agreement is reached, you can make your complaint to the Complaints Committee, c/o 1e Pijnackerstraat 135-a, 3035 GS Rotterdam, or by e-mail to .

Complaints regarding the accommodation should initially be reported on the spot to the facilitator of Bodymind Opleidingen present there.

The right of ownership of all of our trainings and workshops as well as of all the workshop materials provided by Bodymind Opleidingen are under copy-right and remain at all times property by Bodymind Opleidingen.

With filling out this form you declare:

-all questions truthfully answered;

-knowledge that you have read and agree to the above workshop conditions

-agree to the terms and conditions of Bodymind Opleidingen.You can find those under or ask the secretariat for an English version.

- agree with the exception to the general conditions that the advance payment is nonrefundable.

date / place: / Name:

Filling out the date, place name and name applies as a digital signature.

We kindly request you to e-mail this form to:

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