Application Form

CHAKRA INSTITUTE APPLICATION FORM

Please check program for which you are applying:

_____ Spiritual Teachers Training (2, 5 years)

_____ InnerTuning®massage (2,5 years)

_____ Personal Growth (Non-certificate)

Please Contact us for Application form at Chakra Institute, New Hope, PA, USA

Tel: 215-862-3768

Email Here

Or copy and paste the following information:

Name: __________________________________________

Dates ___________

Address: ________________________________________________________

Date of Birth: _______________ Gender ____

_ Phone: ___________________ Email: _________________________________

1. What is your current occupation? _______________________________

2. Do you hold any professional license(s)? Yes _____ No _____. If yes, please attach copies.

3. Why are you interested in this training?

4. Briefly describe related past experiences.

Please mail completed form to Chakra Institute, P.O. Box 34, New Hope, PA 18938.

Alternatively, scan and email .

You will be notified regarding your acceptance for the program.