JILLWENER -

EFT/Tapping Train the Trainer Registration

We're so excited for you to join us for the EFT/Tapping Train The Trainer course. After you submit this form, you will be redirected to a page where you can submit payment (if you haven't already done so) and register for your first 1:1 tapping session with Jill.

First Name *

Last Name *

Pronouns

Email *

City and State *

Occupation *

Why have you chosen to register for the EFT/Tapping 'Train the Trainer' course? *

Are there experiences you've had in the past that are still causing you stress? If so, please indicate if you are comfortable if Jill contacts you to discuss these experiences, in order to maximize your experience in the training. *

How did you find out about the Train the Trainer course? *

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Please share the name of the person that referred you or the specific group/page where you found us on social media: *

Are there special accommodations we can provide to optimize your learning environment? If so please specify here.

Is there anything else you would like us to know at this time?

By clicking yes, you indicate your agreement to the following terms. RELEASE OF LIABILITY: I fully understand that I am entering a program of conditioning and self-help which will include access to tapping training and live group tapping sessions. However, Jill Wener, MD and Conscious Health Meditation + Wellness (CHMW) makes no express or implied guarantee of results or progress. CHMW will, to the best of its ability, endeavor to accomplish the objective(s) for which I enroll in the training. I understand that Jill Wener is an EFT practitioner, certified Conscious Health (Vedic) Meditation Instructor, and a medical doctor. Jill is NOT serving in any medical role as facilitator of the EFT/Tapping 'Train the Trainer' course. I understand that the major purpose of this program is vocational or avocational self-improvement, motivation, relaxation, stress reduction or habit control, and that this program can in no way be construed as medical, mental or psychological treatment. EFT (tapping) at CHMW does NOT replace medical care, and CHMW encourages me to undergo regular, thorough physical examinations by my own physician. CHMW does not assume responsibility for problems of medical, psychogenic or functional origin. The information CHMW is providing to me is only as general information, and CHMW does not assume responsibility for my future EFT trainees or their results with EFT/tapping. As part of the information presented and work we are doing together in the 'Train the Trainer' course, I understand that I will be introduced to a modality called Emotional Freedom Technique (EFT or tapping). I agree to assume and accept full responsibility for any and all risks associated with utilizing EFT and other energy practices whether I participate in single or group sessions.

Yes *