From Complexity to Connection Registration Form

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Email *

Full Name *

Any preferred name, pronouns or identities you wish to share

Address *

Phone number *

Emergency contact name and phone number *

Professional Title or Modality

Your IFSI Level training (1, 2, 3; Certified etc) *

IFS Level 1

IFS Level 2

IFS Level 3

Certified

Other, please describe below

Other:

Required

Please share relevant Trauma Training *

Brief description of your experience of working with complex trauma and IFS *

Brief description of why you would like to attend this workshop and what you hope to get from our time together? *

Additional night B&B - Thursday 27th November *

Yes

Required

Please share any dietary requirements *

Anything else important you would like us to know?

I agree to the storage of my name, contact details, including email and phone number on a password protected device held by the trainers and administrators of this course.

As members of the ICO we abide by their policies around data breaches and complains please see their website www.ICO.org.uk for further details.

Yes

Terms and Conditions

Please confirm you have read and agree to our terms and conditions which can be found here -https://www.heartledexplorations.com/home#thesmallprint

Yes

A copy of your responses will be emailed to the address you provided.

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