Organ Vitality Workshop Registration Form
Apartment, suite, etc
ZIP / Postal Code
Which Organ Vitality workshop do you want to attend?
Blood Organs (September 15th & 22nd)
Organs of Breath and Voice (October 13th & 20th)
Digestive Organs (November 10th & 17th)
all three workshops
Do you want continuing education (CEU) or professional development (PDA) credit for this?
Yes - CEU credit
Yes - PDA credit
Are you new to Body-Mind Centering℠?
what BMC experience have you had?
0 / 180
What interests you about this workshop?
0 / 200
Do you have any movement limitations?
0 / 200
Are you on any medications?
Will your medications affect your participation?
Are you able to speak up if a given exercise does not feel right for you?
Do you have prior experience with any of the following?
Tai Chi or Chi Gung
Other (please specify)
Please indicate which technique(s) and the number of years you have had experience
Please indicate which other technique(s) and the number of years you have had experience