Request edit access
Registration for The Nervous System Lab
This is the sign up form for the four-session immersive, experiential and experimental online course "The Nervous System Lab".

You find all the information  - such as pricing and dates of the course - on its website. 

If you have further questions, please email me at sina.birkholz@gmail.com

Thank you! I am looking forward to exploring our nervous systems together!
Sina

PS: You will receive your registration confirmation and information on how to pay after June 14. No worries, I will treat all registrations in the order in which they came in.

Sign in to Google to save your progress. Learn more
Email *
Your name *
Your email-address *
Your Whatsapp number
What is your motivation for joining this course? *
Is there any experience with or observation on your nervous system that you would like to share with me? *
Is there any fear or concern you have about participating?
Do you agree to keep what other participants share in the group sessions confidential? *
Required
Do you agree to not share recordings of the sessions with anyone else who is not a course participant? *
Required
Do you agree on your voice (NOT your picture/video) being on the recording that is made available to the course participants after each session? *
Required
Are you applying for one of the two reduced fee spots in the course? If yes, please share with me any information regarding your current circumstances that you would like me to consider for determining who receives the spots.
Is there anything else you would like to share?
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms