Registration form - Seminars

First Name*

Last name*

Email*

Phone*

Fecha en la que participas en seminario o retiro *

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

Are you currently pregnant or breast feeding? *

Yes

No

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

Yes

No

If so, please describe.

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

Yes

No

If so, please describe.

Do you use any recreational drugs, including alcohol? *

Yes

No

If so, please describe.

Are you allergic to anything? *

Yes

No

If so, describe what

Is there anything else we should know?

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