Thai Bodywork Certificate Program

Name *

First Name

Last Name

Phone *

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Please select your preferred clinic day: *

Sunday

Monday

Would you like to add clinical work during the semester or wait until the following term? *

Yes, please contact me to add shifts in conjunction with the course work.

I would like to wait until completing the course to engage in clinical work.

How many years of professional practice do you currently have? *

Under 5 years

5 - 10 years

10 - 15 years

15+ years

How would you rate your capacity in knowledge and practice of breathwork? *

Fair

Good

Excellent

How would you rate your ability to stabilize your body? *

Fair

Good

Excellent

How would you rate your understanding of leverage and weight? *

Fair

Good

Excellent

How would you rate your comfort in table position with weight on knees? *

Fair

Good

Excellent