Registration form - Seminars

First Name*

Last name*

Email*

Country refix (+XXX)*

Phone number*

Date you participate in seminar or retreat *

Are you attending the full seminar - 2 days? *

Yes

No

Have you worked with Master Plants before? *

Si

No

If so, please describe your experience. If this is your first time, please describe your motivation now for participating in the seminar or retreat:*

Do you currently have (or have you had in the past) any psychological problems? *

Yes

No

If so, please describe it, if not write NO *

Do you have any physical problems? *

Yes

No

If so, please describe it, if not write NO *

Are you currently pregnant or breastfeeding? *

Yes

No

Do you have a history (past or present) of any heart condition or high blood pressure?*

Yes

No

If so, please describe it, if not write NO *

Do you use any medication (chemical, natural or other)? *

Yes

No

If so, please describe it, if not write NO *

Do you use any recreational drugs, including alcohol? *

Yes

No

If so, please describe it, if not write NO *

Are you allergic to anything? *

Yes

No

If so, describe what, if not, write NO *

Is there anything else we should know?

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