Insight Qigong™ Teacher Training

Name *

First Name

Last Name

Phone *

Country

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date Of Birth *

MM

DD

YYYY

Emergency Contact Phone *

Country

(###)

###

####

Level Of Insight Qigong™ Training Completed: *

IQ 110

IQ 120

IQ 130

None

Do You Have Any Medical Conditions, Physical/Ambulatory Issues, Allergies, Or Any Health/Fitness Concerns To Disclose? *

Answers to these questions do not affect Teacher Training eligibility, and are asked to best meet the needs of accepted applicants. Your application and its contents are kept confidential in accordance with our privacy and health records policies.

Yes

No

Has Any Agency Or Association Ever Investigated Or Taken Action Against You Personally And/Or Your Professional License? *

Yes

No

Not Applicable

Have You Ever Been Convicted Of Any Criminal Activity (Minor Traffic Violations Excluded)? *

Yes

No

Personal Reference Phone *

Country

(###)

###

####

Professional Reference Phone *

Country

(###)

###

####

Your Application Will Be Reviewed ONLY Once your Deposit Has Been Received. *

I understand that upon submission I will be redirected to a secure payment portal to make a tuition deposit ($1200). I understand that my application will NOT be reviewed until a tuition deposit is received. Upon acceptance to the program, your deposit becomes non-refundable. Should you not be accepted, OR you decline enrollment (AT THE TIME OF YOUR INTERVIEW) your deposit will be refunded.* This deposit guarantees your space in the program. Applications received without a tuition deposit will be automatically deleted from our records after 72 hours (at which point, to be considered for program admittance you will need to resubmit an application--with deposit--to reestablish placement in the admissions process queue).

Consent To Receive Electronic Communication *

I understand that submission of this form constitutes agreement to receive electronic communications (email list inclusion). While necessary to process your application continued inclusion is voluntary (you may unsubscribe at any time).

STATEMENT OF ACKNOWLEDGEMENT* *

I have read, understand, and agree to the terms of service and conditions of enrollment set forth by Red Thread Institute. I attest that all information I have provided herein is complete, accurate, and truthful. I understand that agreeing to this statement constitutes an electronic signature.