The LiFT Instructor's Course Online Registration Form

 
     
  Name:
  Address:
  City:
  State/Province:
  Country:
  Zip/Postal Code:
  Phone:
  Fax:
  Email:
  Profession:
  Clientele:
 
 

Professional Experience

 

Describe your present work: Indicate for how long you have been in this practice, include details about the nature of your work and the type of clients you have developed an expertise with. Provide us with the name and phone number of your employer who could be used as a reference, if need be.


 


 
 

Describe your previous employment(s): Indicate for how long you have been in this practice, include details about the nature of your work and the type of clients you have developed an expertise with. Provide us with the name and phone number of your employer who could be used as a reference, if need be.


 
 
 

Please explain how you intend to use the LiFT in your professional practice


 
 
 

How did you hear about the Listening Fitness Instructor's Course?


 
 
 

Professional Qualifications

  Institution 1:
  Degree 1:
  Year 1:
  Institution 2:
  Degree 2:
  Year 2:
 
 

Please check the box beside the course you are interested in attending

     
  October/November
  March
  June