Registration for Boulder, CO workshop

Registration

Mindful Somatic Psychotherapy:
An Introduction to the Hakomi Method
with Melissa Grace, M.A., Certified Hakomi Trainer
September 23-24, 2017 in Boulder, CO

*(Required)

*Your Name

Degree or Credentials (Optional)

*Street:

*City:

*State:

*Zipcode:

*Phone:

Cell phone:

*Your Email

*Occupation:

Employer:

*Are you a student?
YesNo

If student, name of school and program:

*How did you hear about the workshop? (Check one or more)
Hakomi Institute WebsiteHakomi EmailPsychotherapy Networker: (Website, print magazine or conference?)Friend/ReferralShift Network online event (e.g. Hakomi Global Summit)Other (describe):

*Are you taking the workshop as (check one or more):
A prerequisite for the Hakomi Therapy TrainingA therapist or practitioner interested in learning more about HakomiFor personal growthFor other reasons (describe):