Application Form for Touch Of Empathy: Grief Massage Technique and Application

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Email *

City, State and Zip Code - info used to determine best venues for classes.

First Name *

Last Name *

Phone number *

Email address (other than Yahoo or AOL. Gmail or company domain names preferred.) *

Have you taken Touch of Empathy classes with me before? *

Yes

Tell me about your interest in Grief Massage (why now, if you've taken other grief massage classes before, what piques your interest). *

Which option best describes you? *

I am independent and have all of my own clients.

I am part of a private practice but have all of my own clients.

I am an employee and on the payroll of an organization with no private clients (chiropractor office, spa, health club, private owner)

Which option best describes you? *

I am a go getter - not afraid to pick up the phone to makes sales or solve problems, and do whatever I have to because I focus on helping more and more people by building my skills and overcoming hurdles fast..

I struggle to make calls - communication is not my skill and I'm not willing to change this.

I agree to a phone call to learn more about this class and what to expect as part of my application. I have provided a valid phone number. I am ultra professional, excel at communication, am decisive, and meticulous about my self care. I agree to answer the phone when called (or respond immediately to voicemail), and be responsive to emails (inbox and spam folder). TYPE YOUR FULL NAME as your signature and agreement. *

A copy of your responses will be emailed to the address you provided.

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