Earth Heart

The Earth-Heart Institute of Vision and Healing
  Course Application  
 
(Download PDF Application)		  

Name: ____________________________________________________________________________________________
                          Last                    First                 Middle Initial       “Nickname”
Male ⊂⊃    Female ⊂⊃          Date of Birth ______/______/______ 
Address: __________________________________________________________________________________________
___________________________________________________________________________________________________
                 City                  State                  Zip Code
Home Phone (_________) __________________________ Work Phone (_________) __________________________
Email ______________________________________________ Cell Phone (_________) _________________________
How did you hear about us? _______________________________________________________________________

Programs Available
√ place a check mark by each event you wish to attend

(call to discuss the Mentoring program)

The Vision Quest
⊂⊃

100 Person Vision Quest
⊂⊃

 Protector Course
⊂⊃
Seven Levels of Quest
⊂⊃

Private Counseling
⊂⊃

 One-On-One Mentor Program
⊂⊃
Personal Intensive
⊂⊃

Sacred Heart of Darkness
⊂⊃

 Small Group Intensive - Fear
⊂⊃
Small Group Intensive - Sanctuary
⊂⊃

The Training
⊂⊃

 Lighten Up: A Healing Retreat
⊂⊃
2-Week Retreat
⊂⊃

Women's Retreat
⊂⊃

 Your Wild Creative Soul
⊂⊃
Compass of the Heart
⊂⊃

Conscious Union
⊂⊃

  
     
Location: __________________________________________________________
Date: _____________________________________________________________
     

***Note on the donation for the Vision Quest. It is run on a suggested donation basis only to help cover the many logistical costs of running this program, so that we can continue to offer it (land rental, food and supplies, insurance, travel expenses, and staff). More importantly, the donation reflects your commitment and respect for this ancient practice, and for the people who will guide and protect you.
Your application will not be considered complete unless we receive all of the following:
Please mail this application (with deposit, letter, medical form, and a recent photo) to
Earth-Heart, P.O. Box 926, Topanga, CA 90290
Cancellation Policy: 
If you cancel your reservation in a program you have applied for at least 2 weeks before the start of the class, of the $300 nonrefundable deposit, Earth-Heart allows $150 to be transferred (one time only) to any other Earth-Heart program within 12 months of the original class application. If you do not notify Earth-Heart of your cancellation at least two weeks before the start of the class, none of the deposit is transferable.