Location and date of workshop you are applying for (ex: Santa Fe May 2014): *
Gender * Male Female
City / Town *
Province or State *
Postal Code / Zip *
Telephone (area) + phone number *
How did you hear about the program? *
What challenge or condition brings you to this training?
When did your issues begin?
Do you know what triggered this issue?
How has this issue affected your life?
I want you to envision yourself completely recovered from this issue. What is available to you then?
How will this affect your daily living?
How will it make your life more enriching?
How will all this affect your friends and family?
Any other information you wish to add?
Re-type Email Address:
If you cancel within 30 days of the program registration deadline, you will receive 100% of your registration fee back ( less a $150 administration charge). If you cancel within 15 days of the registration deadline you will receive 75% of their money back (less a $150 administration charge). If you cancel within one week of the registration deadline you will receive 50% of your money back (less a $150 administration fee) . If you cancel after the registration deadline, you will not receive any refund. By checking this box, you acknowledge that you have read this condition and agree to its terms: *
DNRS endeavours to provide an optimal learning environment by limiting the group size and choosing venues that are environmentally aware. While we do our utmost to ensure each location meets our stringent standards, we cannot guarantee to meet the needs of each individual participant due to circumstances beyond our control. By checking this box, you acknowledge that you have read this condition and agree to its terms: *
All reasonable endeavors will be made to hold the program as scheduled. However, DNRS reserves the right to modify the program. Neither DNRS, nor their officers, directors, employees, representatives or agents, shall be held liable by any person as a result of the cancellation of the program or any of the arrangements, programs or plans connected therewith, or for any injury, damage or inconvenience which may be suffered by any person while traveling to or from, or during such person’s presence at the DNRS program. Participants and their guests are advised to purchase their own insurance against any such occurrences. By checking this box, you acknowledge that you have read this condition and agree to its terms: *