Application Form for Breathwork Teacher Training

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Please fill out all the details below. Note this is only a application form, the final acceptance to the training is after a personal interview.

Email *

Name & Phone Nr. (so we can get in touch with you)

Date of Birth

When would you like to join our training ? The first module.
*

Earth Module Oct 25 in Ericeira

Earth Module June 26 , Tavira, Algarve

Other:

How did you hear about this training ?
*

Did you ever participate in one of my workshops/retreats/events ? If yes please specify.
*

yes

Other:

If you answered yes, in the question above, please share where and when did you experience my work?

What is your main Intention in taking this training ?
*

Please share what is your background ? Current work, education, ect
*

How do you wish to integrate the knowledge of breathwork into your life/work ?
*

Please share your instagram/ website / facebook details below!

Thanks for being interested in this powerful work. Within the next days you will be contacted by me to schedule a personal interview!

With Love and Gratitude

Mela Mariposa

A copy of your responses will be emailed to the address you provided.

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