Qi Studio Bursary Application Form
Hello dear soul! 

Thank you for taking the courageous step of applying for the bursary membership. I'm committed to making this practice available to everyone who is interested and might need an extra Qi boost in their life!

Please fill in this form so I can get a realistic understanding of your situation, and your reasons for applying.

Sign in to Google to save your progress. Learn more
Email *
What is your first name - and/or how would you like to be addressed?
 *
And your last?
 *
In your own words, why you are applying for a bursary membership and how might Qi Gong support you on your journey? *
What do you feel is reasonable and possible for you to pay at this time?
 *
Is there something you would be willing to offer in return for the membership?
 *
Required
Would you be open to reassessing your chosen payment after a year and potentially upgrading to a Regular Membership fee?
 *
Finally, I'd love to know where you heard about the Qi Studio Membership... *
Required
Thanks very much for taking the time to apply for a bursary.

I aim to get back to you within two weeks (except in August, where it might be a month!). If you haven't heard from me within these time frames, please prompt me as I might not have seen your form yet! You can use this email: eline@elinekieft.com.

I hope that Qi Gong helps cultivate a harmonious relationship with your body, and that the bursary structure supports you in balancing heart, mind, and soul in continuous connection with the living world around you.
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