Hemi-Sync personal growth & transformation workshop register | KeyQuest

KeyQuest Workshop Registration

Workshop Registration Form

KeyQuest LLC

Please note: all fields are required

I am over the age of 18. (If not, please contact us and do not register online.)

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Workshop Title:	Workshop Date:
Workshop Location:	Tuition:
PARTICIPANT INFORMATION
Name:	Name you like to be called:
Home phone:	Cell phone:
Address:	Email:
City/Town:	State:
Zip Code:
IMPORTANT INFORMATION Please read the following three sections and check the corresponding boxes. You can sign at the workshop. CANCELLATION POLICY 1. If a registrant cancels more than 3 weeks before the start date of the workshop, the full tuition (minus $5) is refunded. 2. If a registrant cancels less than 3 weeks before the start date of the workshop, the full tuition (minus $25) is refunded. 3. If a workshop is canceled, the full tuition is refunded. 4. If a participant leaves before the end of a workshop, the balance of the tuition is refunded on a pro-rated basis. 5. If a registrant is a no-show for a workshop, 50% of the full tuition amount is refunded. I have read, understand, and agree to the above. HEMI-SYNC® TECHNOLOGY Hemi-Sync® is a safe and effective technology which has been refined during decades of scientific and clinical research. However, if I have not used Hemi-Sync® before, I will listen to the Gateway Voyage Introductory Exercise (after reading How to Listen) on The Monroe Institute website as soon as I can after registering and before participating in the workshop. If I have any questions or concerns before or after listening to the exercise, I will contact KeyQuest. If I have epilepsy or have a tendency towards seizures, auditory disorders, or adverse mental condition(s), I will disclose this in Question #5 below. I understand that I should not listen to Hemi-Sync® without having first consulted with my physician. I understand further that I may be required to provide KeyQuest LLC with a signed and dated statement from my physician in order to be able to participate in the workshop. If I, my physician, or KeyQuest LLC deem that I am unsuited for participation in the workshop, my tuition will be refunded in its entirety, including the deposit. I have read, understand, and agree to the above.
RELEASE The purpose of the KeyQuest workshops is to educate and to provide a context for meaningful personal experiences to enable participants to enhance their lives. I release Clifford A. Walker, Ellen E. Jones-Walker, KeyQuest LLC, and all related persons and entities from all claims and demands which I have, or may have, against them with respect to any loss, damage, or injury of any nature caused or alleged to be caused directly or indirectly as a result of workshop activities. I declare that I enter into these activities voluntarily in an effort to increase my knowledge of the subjects under investigation. Workshop information and experiences are in no way intended as a substitute for medical or psychological diagnosis, counseling, and/or treatment. I have read, understand, and agree to the above.
Participant's Signature:	Date:
PLEASE ANSWER THE FOLLOWING QUESTIONS:
1. Why are you taking this workshop? What do you hope to get out of it?
2. Have you ever used Hemi-Sync® audio technology before? If yes, when and to what extent?
3. Do you have any hearing issues which might affect your participation in Hemi-Sync® audio exercises? If yes, please explain:
4. Do you have any mobility issues (including difficulty going up/down steps or getting onto/off of an air mattress? If yes, please explain:
5. Do you have any other conditions or special needs which we should know about? If yes, please explain:
6. How did you find out about the workshop?
You will be taken to the Payment Page next. You will receive an email confirmation of your registration, including the information you have provided above.