Please fill out the registration form
Event Date: Saturday July 27, 2019
Recommended: Journey experience or meditation
IEMI student may repeat the full day training or half group practice.
Event Address: 9 Crown Street Milford, CT 06460
Time: 9 am - 5 pm
Contact us at (203) 980-4103 or
Integrative Energy Medicine Institute Certification
Instructor: Chantal Guillou-Brennan, CHT, IEMT, Shamanic Practitioner.
First & Last Name to Appear on Your Certificate *
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Your Email *
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Cell Phone *
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Date *
Payment *
Cash, check, or Credit Card: Square-up or Paypal with 4% fee. (Avoid fee when using friend & family with .) Deposit secures your place in the class & balance is due in cash at the door. Registering without prepay does not secure your place in the class; an email or text notification will be sent when the class becomes full. YOU'LL RECEIVE AN EMAIL WITH LINK TO THE PAYMENT PAGE AFTER SUBMITTING THIS FORM.
Who recommend this class to you? (They will earn $10 toward their "next" IEMI training).
Your answer
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:
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