Register Family Constellation

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Workshop : FAMILY / SYSTEMIC CONSTELLATION WORKSHOP

THE AMBEDKAR HALL, INDIAN SOCAL INSTITUTE

Date : FRI & SAT 25TH & 26TH OCTOBER 2024

Family Constellations Registration Form

First Name

Sur Name

Age

Date of Birth

Gender

Male

Female

Others

Occupation

Address

Address Line

City

State

Zip Code

Country

Email

Mobile No

WhatsApp no.

Please be authentic, honest and specific as you answer the following:

1) Briefly describe any challenges you face in your life right now eg. in the area of career, health, family, relationships.

2) Do you have medical problems like, diabetes, heart condition, high blood pressure, frequent headaches etc? If so, identify and state if under medication for the same.

3) Do you have emotional health issues like depression, bipolar, schizophrenia etc. If so, identify and state if under medication for the same.

4) By attending this workshop, I would like...

I would like to participate as

Seeker

Representative / in the holding circle

Note: Check link for clarification of positions. Please note that the position that you have asked for may not be available at the moment. You will be intimated of availability.

I will be remitting the fee from a bank

Within Karnataka

Outside of Karnataka

I understand that this workshop involves experiential processes and I am willing to participate in taking responsibility for myself.

Date

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