The Moving Cycle Institute

Registration Form

Full Name *

Address *

Email *

Phone *

Date *

Short Bio (approximately 50 - 75 words) if signing up for Phase One (education & trainings, relevant life experience)

Course registering for *

Course Dates and Location *

Would you like recommendations for accommodations during the course?

YES

Do we have your permission to put your email address into our system so that you can receive course announcements, last minute notifications, and our newsletter? Your information will never be given out, and contact will be approximately 4 times a year)

YES

Do we have your permission to include your name and email address on a list of participants in the course, to be handed out to all participants on the last day?

YES

After the course, would you like to be added to the list of people who have access to Christine’s Dropbox folder where additional readings are posted, as well as course curricula and handouts?

YES

Please check here to acknowledge that you have read and agree to the policies stated above *

YES