Masterson Method™ Integrated Equine Performance Bodywork™ Level 1 Course Registration

The following questionnaire is your application to the Equine Performance Bodywork Level 1 Certification Course. It is a prerequisite to have attended a Weekend Seminar-Workshop.

While it is important to ensure that participants have sufficient knowledge and background to make the course worth their while, filing out this questionnaire will also help us to present the course in a way that will compliment participant's individual knowledge, background & goals.

Please fill out the form below. After you have submitted the form, please mail a check for $250 to hold your place in the Level 1 Certification course you are applying for.

Mail the check to:
Jim Masterson
Masterson Equine Services
123 North Main, #8
Fairfield, IA 52556

Note: No registration is complete without a deposit. You will receive a confirmation email when your registration is complete.

Tuition is due in full 2 weeks prior to the beginning of the course.

The following questionnaire is your application to the Equine Performance Bodywork Level 1 Certification Course.

Please see our 2010 Calendar page for schedule Seminar-Workshops and tuition.

Date of Level 1 Course

Location of Seminar-Workshop you have attended

Full Name

Address

City

State

Zip Code

Phone Number

Cell

Email

Please list any equine therapy schools, study or related courses you have attended or are certified in, and when.

Are you certified in any human therapies, and in what areas do you specialize?

Any veterinary or medical background?

Are you already practicing your therapy, and for how long? Are you full-time, part-time, or student?

Are there any specialized areas or alternative therapies that you have experience or special interest in (for example, cranial sacral, acupuncture-pressure, myo-fascial)?

In order to ascertain your comfort level with some of the horses we will be working with, please answer the following:

Are you currently working with a horse or horses on a daily or weekly basis?

Are you comfortable working alone in a stall with an animated performance horse?

Are you comfortable picking up and working with all four legs of the horse?

What do you wish to accomplish with this course: What are your goals?

Anything else you would like us to know or that you would like to know about the course?