Seminar Registration Form “Awakened Mind Coach” - … · Seminar Registration Form “Awakened Mind® Coach” - Complete Training Program - Yes, I want to attend the complete

 mindsurfer® academy Andrea Groh Habergasse 7 D – 96047 Bamberg

+40 (0)170 – 954 38 88 [email protected] www.mindsurfer-academy.com

IBAN: BIC: St.-Nr.:

DE13 7705 0000 0300 5232 97 BYLADEM1SKB 207/222/79879

mindsurfer® academy • Habergasse 7 • D-96047 Bamberg

An mindsurfer® academy Andrea Groh Habergasse 7 96047 Bamberg Germany

Seminar Registration Form “Awakened Mind® Coach” - Complete Training Program -

Yes, I want to attend the complete “Awakened Mind® Coach“ Training Program: Seminar Dates: Seminar 1: Seminar 2: Seminar 3: Examination:

Course Instructor Andrea Groh, Awakened Mind® Practitioner Trainer max. number of participants 12 Seminar duration 6 days each seminar Seminar Location: Seminar Fees: 3.452,00€ / 2.416,00€* (* reduced prize for students and apprentices)

Payment Info: Please transfer the Seminar Fee to: Account holder mindsurfer academy / Andrea Groh IBAN DE 13 7705 0000 0300 5232 97 BIC BYLADEM1SKB Bank Sparkasse Bamberg

 mindsurfer® academy Andrea Groh Habergasse 7 D – 96047 Bamberg

+40 (0)170 – 954 38 88 [email protected] www.mindsurfer-academy.com

IBAN: BIC: St.-Nr.:

DE13 7705 0000 0300 5232 97 BYLADEM1SKB 207/222/79879

Participant Info:

First Name, Last Name

Date of birth

Street address

City / State / Zip

Phone

E-Mail

Confirmation You will receive confirmation of registration via mail. If you do not receive confirmation before your scheduled event, please phone +49 170 954 38 88 or email to [email protected]. Information Detailed information about arrival and place of event will be emailed to you before the event. For further information please visit www.mindsurfer-academy.com or contact us. Cancellations and Substitutions Payment is required in advance. If a written request for refund is made 30 or more days before the event, the registration fee, less a 15,00 € administration fee, will be refunded. If a written request for refund is made 14 days before the event, the registration fee will be refunded to 50%. If a cancellation request is made less than 14 days before the event, or if you fail to attend the event, your registration fee is forfeited. Substitutions are accepted without additional charge.

Disclaimer This is to certify that I am not pregnant, mentally healthy and that I do not have any physical illnesses that are contraindicated for altered states of consciousness similar to hypnosis. Physical contraindications could be e.g. epilepsy and similar attack disease, heart disease, a recent heart attack, apoplectic seizure or thrombosis.

Date Signature Please complete this form and mail it to: contact@ mindsurfer-academy or send it to mindsurfer® academy, Andrea Groh, Habergasse 7, D-96047 Bamberg.