Intake form

Please do NOT write in ALL CAPITALS.

First Name (required)

Last Name (required)

Street (required)

Postal Code (required)

City (required)

Country (required)

Your Email (required)

Website

Landline phone

Mobile phone

In the following fields you can enter how you want your name to be displayed on the certificate that you will receive upon completion of the training.

• In the first box you should fill in your preferred name exactly as you want it on the certificate. It will appear on the certificate in big curly letters. This can be in any orthography that you want (Greek, Cyrillic, etc). This field is mandatory.
• The second box is optional and can be used as an alternative text that will appear in smaller letters under the one you filled in above. This can be an alternative orthography (e.g. your name in Greek in the first box and in Latin orthography in this box, or the other way around). You can also use this field if you have a shamanic name for instance that you want to appear on the certificate.

Preferred name (required)

Secondary name

Please prove you are human by selecting the Cup.