Please fill out the registration form
Event Date: Tuesday June 5, 2018 or Saturday June 9, 2018
Time: 9 am - 4 pm
Event Address: 9 Crown Street Milford CT
Prerequisite: Recommended Shamanism 101
Contact us at (203) 980-4103 or CGB@IntegrativeEnergyMedicine.com
Integrative Energy Medicine Institute Certification
Instructor: Chantal Guillou-Brennan, CHT, IEMT, Shamanic Practitioner.
First & Last Name to Appear on Your Certificate
Tuesday June 5, 2018.
Saturday June 9, 2018.
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.
$175 cash at the door.
Repeat IEMI student $75 cash at the door.
Who recommend this class to you? (They will earn $10 toward their "next" IEMI training).
Yes I took IEMI Shamanism 101
No, I take full responsibility for my ability to participate.
CONSENT AGREEMENT: READ & APPROVED
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:
I HAVE READ AND APPROVE THIS CONSENT AGREEMENT.
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