Registration Form
Please cut and paste this form into an email and send it to sjberman@me.com or
mail it with your deposit to 2615 Cone Ave. Durham,NC 27704
Name:
Address:
Phone:
Email:
Date of Birth:
Tuition: $495 per Class or $2400 if paid in full.
There is a $100 (non-refundable) deposit.
Send to: Sarajo Berman. 2615 Cone Ave., Durham, NC 27704
BRIEFLY ANSWER THE FOLLOWING QUESTIONS.
1. What kind of health care services do you offer your clients? Number of years?
2. What draws you to participate in this workshop?
3. Do you have a practice that brings you into silence, stillness, out of doing and/or that quiets your mind? What is that practice?
4. How do you nurture yourself?
5. What brings beauty into your life?
6. What makes you feel good ?
Suggested viewing prior to class:
Youtube
Embryology – The Midline – Carol Agneessens
Michael Kern - Biodynamics
Do you want to receive CEU credits? Please Print your name as you want it on your certificate.
Thank You and I look forward to working with you. sarajo
Please cut and paste this form into an email and send it to sjberman@me.com or
mail it with your deposit to 2615 Cone Ave. Durham,NC 27704
Name:
Address:
Phone:
Email:
Date of Birth:
Tuition: $495 per Class or $2400 if paid in full.
There is a $100 (non-refundable) deposit.
Send to: Sarajo Berman. 2615 Cone Ave., Durham, NC 27704
BRIEFLY ANSWER THE FOLLOWING QUESTIONS.
1. What kind of health care services do you offer your clients? Number of years?
2. What draws you to participate in this workshop?
3. Do you have a practice that brings you into silence, stillness, out of doing and/or that quiets your mind? What is that practice?
4. How do you nurture yourself?
5. What brings beauty into your life?
6. What makes you feel good ?
Suggested viewing prior to class:
Youtube
Embryology – The Midline – Carol Agneessens
Michael Kern - Biodynamics
Do you want to receive CEU credits? Please Print your name as you want it on your certificate.
Thank You and I look forward to working with you. sarajo