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Student Information Form
The transformational value of this course starts here and we invite you to take your time filling in this form.
The information submitted is for the eyes of the program faculty on this course to support your process, and help provide a safe container for all participants.
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Legal Name
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Your answer
Date of Birth/Age
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Your answer
Gender
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Your answer
Preferred Name and Pronouns
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Your answer
Nationality/Place of Birth
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Your answer
Address
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Your answer
Email
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Your answer
Phone Number
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Your answer
Facebook Profile Link
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Your answer
Emergency Contact name, number and email
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Your answer
Food Allergies or Dietary Restrictions
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None
Vegetarian
Vegan
Dairy Free
Gluten Free
Other:
Required
Have you ever attended and completed an ISTA (International School of Temple Arts) Level 1 or Level 2 Training?
If so - when, where and with what Lead Faculty?
It is not essential that you have done a training with ISTA to attend this course.
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Your answer
1) What do you want to gain from participating in the Blue Lotus Initiation?
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Your answer
2) What previous events, if any, have you attended that explored the topics of healing, tantra, plant medicine, sexuality, breath-work, spirituality, and/or meditation?
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Your answer
3) What forms of personal growth work have you undertaken in your life? (therapy, seminars, yogic training, etc.)
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Your answer
4) What experience do you have facilitating or offering any form of guided / therapeutic work ? Ie. facilitation or session work.
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Your answer
5) How do you intend to apply the understanding you gain from attending this training?
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Your answer
6) Please share any recent major life events--deaths, break ups, trauma, business/career changes or other emotional transitions. If you are not sure whether or not to include something, we ask that you share it here as this type of information helps us to hold a better container for our students as they move through this work.
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Your answer
Are you currently taking any prescription medication?
If so - please list below the name of the medications and reason for taking them.
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Your answer
To complete your registration and reserve your spot at the Egyptian Blue Lotus Experience you will need to put down a $500 USD Deposit, if you haven't already. The $500 can be sent in the following ways,
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Ask for Crypto Address
Zelle: Name on account - Javier Martinez and email -
jms815@outlook.com
PayPal: email
jms815@outlook.com
Venmo: @Javi-815
Cash App: $javi815
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