Please fill out this registration
Event Date: 4 sessions: The first three sessions are 1.5 hour long, the training is 3 hour long
Please fill registration form be informed when the next series is occurring
Event Address: 9 Crown Street Milford, CT 06460
Contact us at (203) 980-4103 or
Integrative Energy Medicine Institute Certification
Instructor: Chantal Guillou-Brennan, CHT, IEMT, Shamanic Practitioner.
First & Last Name *
Your answer
Your Email *
Your answer
Cell Phone *
Your answer
Register *
Choose morning or afternoon session on 10/22, 10/29, 11/2 and 11/5, 2018
Payment *
This initiation/training must be prepaid with CC with 4% surcharge. Cash or checks also accepted: instruction emailed upon registration.
I have chosen to experience the above workshop of my own free will. I am aware that the process of studying/practicing healing modalities may bring up issues of a highly personal nature that may cause me to experience emotional or physical responses which may be unexpected and/or unpleasant. I understand that none of the healing modality taught are a substitute for medical care and I am advise to discuss my personal physical or mental issues with my physician. Additionally, I should continue any present medical treatment and consult my medical doctor for treatment of any illness. I confirm that I do not currently suffer from any mental or physical impairment, and have not been diagnosed in the past with any disorder, condition, or injury, either physical or mental, that might make it un-advisable for me to study the modality I am enrolling into.By signing this document below, I willingly agree to hold harmless and release from all liability the organizers, facilitators, and participants in this workshop, including Chantal Guillou-Brennan, IEMP, CHT, CQHHT and the Integrative Energy Medicine Institute. Read and approved:
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.