Feldenkrais Training Academy ApplicationWe look forward to receiving your completed application. Please answer the questions below, upload the requested information, and submit your registration fee. We will process your application in the order received and respond as soon as possible.I want to: Pay 12 installments of $2,033.33 each Pay 1 payment of $22,500 for a 10% discount Personal DetailsName* First Last Date of Birth* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Day Phone*Evening Phone*Mobile Phone*Email Address* Enter Email Confirm Email Please answer all the following questions.Briefly describe your experience with the Feldenkrais Method, and how it has affected you personally.*What is your interest in entering into the Feldenkrais Training Academy? What are your intentions for utilizing the Feldenkrais Method personally and professionally?*There are many opportunities to take a Feldenkrais training. Why is the FTA right for you?*Please provide a general statement regarding your ability to meet the financial requirements of the training.*Tell us something that you're passionate about (e.g., favorite book or poem; recent travel; activism...)*Is there anything else you would like us to know about you?*Please list a few dates/times in the next two weeks that you are available to talk with Educational Director Jeff Haller, as part of the application process. We require three items to be uploaded Please read the instructions for this section carefully. Missing information will delay your application.1. Curriculum VitaePlease upload your curriculum vitae.*Accepted file types: pdf, doc, docx.2. A Letter Of RecommendationPlease upload your letter of recommendation (from a Feldenkrais Practitioner, if possible).*Accepted file types: pdf, doc, docx.3. PhotographPlease upload a recent headshot.*Accepted file types: jpg, png, gif, pdf.Pay Registration Fee$100 non-refundable registration fee is due now on submission of this form (refunded only if application is not approved).* Price: $100.00 Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20182019202020212022202320242025202620272028202920302031203220332034203520362037 Expiration Date Security Code Cardholder Name This iframe contains the logic required to handle Ajax powered Gravity Forms.