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.
 
 
 

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

Previous Work: 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