Seminar Request Form Would you like to attend a workshop in your hometown? yesno Would you like to host a workshop in your hometown? yesno (A 15-person minimum is required to hold a workshop) If so, please provide us with the following information: Your Name (required) Home Phone Your Email (required) Address City State Country Zip Code If different from where you live, where you would like to hold the event? Facility Name Facility Telephone Number Facility Address City State Country Zip Code Would you like to hold the event in your house? YesNo If so, please answer the following questions. Is your house large enough to hold 15 participants comfortably sitting in a half circle on chairs? YesNo Is your house quiet and free of telephone and other noise? YesNo Is the space clean and smoke free? YesNo Do you have fragrant candles or other toxic products? YesNo Do you have any pets? (Some people are allergic to animals) YesNo If so, what kind of pets and how many do you have? Any comment? [recaptcha] Thank you for your time.