APPLICATION FOR TANTRA MASSAGE TRAINING COURSE
*Name*Surname*Email Address*Gender<Female><Male>*Age Group<18-29><30-45><over 45>Address*City or Town*Country of ResidenceAustraliaAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustriaAzerbaijanBahamaBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBrunei DarussalamBulgariaBurkina FasoBurundiCôte D ivoire (Ivory Coast)CambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIraqIrelandIslamic Republic of IranIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, Democratic Peoples Republic ofKorea, Republic ofKuwaitKyrgyzstanLao Peoples Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldova, Republic ofMonacoMongoliaMonserratMoroccoMozambiqueMyanmarNambiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint LuciaSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSpainSri LankaSt. HelenaSt. Kitts and NevisSt. Pierre and MiquelonSt. Vincent and the GrenadinesSudanSurinameSvalbard and Jan Mayen IslandsSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwan, Province of ChinaTajikistanTanzania, United Republic ofThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom (Great Britain)United States Minor Outlying IslandsUnited States of AmericaUnited States Virgin IslandsUnknown or unspecified countryUruguayUzbekistanVanuatuVatican City StateVenezuelaViet NamWallis and Futuna IslandsWestern SaharaYemenYugoslaviaZaireZambiaZimbabwe*Mobile phone number*Relationship Status<Single><Married><Other>*Children?<No><Yes><Dependent><Independent>*Your Experience<massage><tantra><healing><coaching><counselling><meditation><spiritual courses><yoga><martial arts><personal development><other modalities><Other>*Details of your experience*Any tantra experience (indicate as many as apply)<No><Yes><read tantra books><tantra courses, workshops, seminars><practiced with partner><other>*Details of tantra courses/ teachers etc<Professionally independent><Affiliate><Referrals><Personal Use><other>*Timing<Part-time><full-time>*Your Venue<work from home><clinic or other rooms><other>*Are you prepared to travel to give sessions?<Yes><No>*Do you have a massage table?<Yes><No>*Are you prepared to massage Men Women Couples<Yes, all><No><Maybe><just men><just women><couples>*Your motivation - reasons for wanting to learn tantra massageAnything else you would like to tell me?
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Thank you
Ally
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