Enlightenment Intensive Participant Questionaire

Contact Information

* First Name :

* Last Name :

Address 1 :

Address 2 :

City :

State :

Zip :

Phone :

Email Address :

Emergency Contact Information

How many Enlightenment Intensives have you taken?

What questions have you worked on?

Briefly list any other growth work you have done?

Briefly describe any therapy, studies, or sisciplines in which you are currently engaged:

List any prescription drugs or special medications you are taking:

Select any that apply:

Do you drink coffee?

Do you drink alcohol?

Do you smoke tobacco?

Do you use recreational drugs?

Other

Do you have any health problems we should know about?

Please indicate any food allergies or sensitivities you have: