Application

Application for Qigong Practice Leader and Teacher Training
Daoist/Tibetan Clinical Qigong Energy Healing

* Indicates required field

Name *

First

Last

Phone Number *

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Please indicate your interest in our programs

Choose Any *

Practice Leader/ Teacher Training - 200 Hours

Daoist/Tibetan Clinical Qigong Energy Healing Training *

Please Explain or detail your interest in either the Qigong Practice Leader and Teacher Program, the Daoist/Tibetan Clinical Qigong Energy Healing Program. Example- wishing to offer Qigong to your community...

Response: *

Please describe any credentials and/or training you have gone through previous to this program. Please include all types of relevant trainings. For example, Energy Healing, Medical, Psychology, Social Work, Physical Therapy, Massage, etc. List any modality you have been previous taught.

Previous Credentials and/or training *

Terms & Conditions

Susi Rosinski, WNYQigong and the Academy of Qi have the right to use any photographs and/or video taken during the sessions for promotional or other legal use as they desire. Participating in sessions indicates your acceptance of being in potential photos or videos without compensation for your likeness.
The program may be changed or adjusted to fit into the contraints and/or abilities of the participants. These changed are at the discretion of the instructor and/or the management team
You agree to release all liability for any injury to your person, mental state, emotional state, your spiritual state. You will hold any instructors, management, volunteers, other participants or the organizations they are members of harmless of any such perceived or actual injury.

Indicate your Agreement to continue *

I Agree to the Terms & Conditions

Submit