Fragrance of the Lotus Advanced Tantra & Teacher Certification Program 2011 Application If you have questions, or need assistance completing this Application, please feel free to contact Chandra Bindu Tantra Institute at: tantra@chandrabindutantrainstitute.com Name Address City State Choose One Alaska Alabama Arizona Arkansas California Colorado Connecticut Delaware Dist.Of Columbia Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming County/Province Postal Code Country E-mail address Home phone Mobile phone Emergency Contact Emergency Contact phone Fax What style of Tantra do you currently practice? What styles have you studied before? Where? With whom? For how long? Do you have a daily practice? If so, please describe. Do you have any physical or emotional health issues that would prevent your full participation in the Fragrance of the Lotus Advanced Tantra & Teacher Certification Program? How do you handle stress? Do you currently teach Tantra? Choose One Yes No If yes, for how long and what style(s)? Why do you practice Tantra? What do you wish to focus on in your further explorations of Tantra? Do you understand that the Fragrance of the Lotus Advanced Tantra & Teacher Certification Program is an advanced training, and is demanding on many levels including, but not limited to; time commitment, financial commitment, emotional development, self-awareness, world travel, working with others, working with a team, spiritual development, sexual development? Choose One Yes No Do you feel you have adequate resources to give the Fragrance of the Lotus Advanced Tantra & Teacher Certification Program your focus and attention for the duration? Choose One Yes No Why do you wish to participate in the Fragrance of the Lotus Advanced Tantra & Teacher Certification Program? What are you expectations of the Fragrance of the Lotus Advanced Tantra & Teacher Certification Program ? Are you interested in becoming certified by Chandra Bindu Tantra Institute? Choose One Yes No Fragrance of the Lotus Schedule Module 1 . Santa Barbara, California . January 17-26, 2011 Module 2 . Wicklow, Ireland . May 16-25, 2011 Module 3 . Pune, India . December 5-14, 2011 Terms of Participation You must be present, from beginning to end, for each session of each of the three modules of the Fragrance of the Lotus Advanced Tantra & Teacher Certification Program. Failure to do so may result in your dismissal without reimbursement. Teacher Certification Track: all assignments & projects must be completed and submitted on time. Failure to do so may result in failure to receive certificate. I have read and accept the schedule and terms of participation for the Fragrance of the Lotus Advanced Tantra & Teacher Certification Program. Choose One Yes No Payment Agreement Tuition includes three training modules, course materials, and meals & lodging for the three modules. Travel costs and personal materials are not included. The tuition for Fragrance of the Lotus Advanced Tantra and Teacher Certification Program is $6,935 US dollars. I have read and accept the terms of the Payment Agreement and Cancellation Policies. Choose One Yes No Fees The full tuition is due when your application is approved. If you cancel from the training, you will be charged a cancellation fee. Please read the cancellation chart. Tuition may not be transferred to another event. CANCELLATION FEES APPLY AS FOLLOWS:   Time of cancellation Cancellation fee per person A 60 or more days prior to training start date (except as noted in "E" below) 50% of Entire Tuition B 14-59 days prior to training start date (except as noted in "E" below) Entire tuition C 0-13 days prior to training start date Entire tuition D "No-show" at the starting point, or you leave during the training Entire tuition YOU WILL NOT PAY CANCELLATION FEES IF: E You cancel from a confirmed space in the training within 14 days of when Chandra Bindu Tantra Institute receives your payment. NOTE: This 14-day grace period does not apply if the training start date is within 30 days of when Chandra Bindu Tantra Institute receives your registration. F You are not approved by the training leader (after that training leader has received your application). G You cancel within 14 days of a Chandra Bindu Tantra Institute change in training date, training leader, and/or training price. H You cancel from a waitlist. I You fail to move off a waitlist onto the training as a signed-up participant.