Student Information Form
Please note that the training is full and we are now receiving only applications for the Waiting List. If you wish to be added to the Waiting List fill out the form and Javi Martinez the organizer will contact you as soon as she can. 
Thank you

The transformational value of this course starts here and we invite you to take your time filling in this form.
The information submitted is for the eyes of the program faculty on this course to support your process, and help provide a safe container for all participants.
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Email *
Legal Name *
Date of Birth/Age *
Phone Number *
Gender *
Preferred Name and Pronouns *
Nationality/Place of Birth *
Address *
Facebook Profile Link *
Emergency Contact name, number and email *
Food Allergies or Dietary Restrictions *
What do you want to gain from participating in the Shamanic Kink Immersion? What are your Intentions? *
What previous events, if any, have you attended that explored the topics of healing, tantra, plant medicine, sexuality, breath-work, spirituality, and/or meditation? *
What forms of personal growth work have you undertaken in your life? (therapy, seminars, yogic training, etc.) *
Have you ever attended and completed an ISTA (International School of Temple Arts) Level 1 or Level 2 Training? 
If so - when, where and with what Lead Faculty?

It is not essential that you have done a training with ISTA to attend this course. 
What experience do you have facilitating or offering any form of guided / therapeutic work ? Ie. facilitation or session work.  *
How do you intend to apply the understanding you gain from attending this training? *
Please share any recent major life events--deaths, break ups, trauma, business/career changes or other emotional transitions. If you are not sure whether or not to include something, we ask that you share it here as this type of information helps us to hold a better container for our students as they move through this work. *
Are you currently taking any prescription medication? 
If so - please list below the name of the medications and reason for taking them. 
To complete your registration and reserve your spot at the Shamanic Kink Immersion you will need to put down a $500 USD Deposit (If you have not already done so). The $500 can be sent in the following ways *
How did you hear about this course, who recommended it to you? *
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