ADVENTURES IN AWARENESS(TM) WORKSHOP APPLICATION
                            9852 E. Skyview Drive                        
                              Tucson, AZ  85748
                         please fill in all the blanks 

Name:________________________________________________________________________

Address:_____________________________________________________________________

City:_______________________________ State:__________________  Zip:__________

Country:_______________________________

Phone:_____________________  Cell:________________________

E-mail:____________________

Website:_____________________________________________________________________

Date of Birth:___________________________  Age:______________________________

Height & Weight:____________________________________________________________

Eating Plan:____________ Vegetarian?_____ Considerations?

Sensitivities?___________

Name of Workshop attending – Date & Place:________________________________

Lodgings while attending:____________________________________________________

Brief summary of current life situation:_____________________________________

Are you pregnant?_____________

Life changing circumstances: marriage, divorce, death of a loved one,
career re-frames, geographic re-location, health challenges, new status as
grandparent, include any sensory or mobility issues, allergies, special
needs?  

While horse experience is not essential, briefly describe your horse
background.___________________________________________________________________

______________________________________________________________________________

I identify as: Horse Professional_____Animal handler____
Health Professional____Program Administrator_____ Educator:____
Student:____ Interested in Stress Skills ____ Other: (please specify) 

I am aware that this is an “experiential workshop” – learning through
doing.  I know I will be discovering more about myself as I learn to work with
horses as colleagues in equine guided education.  I am aware that equine
facilitated experiential learning process work evokes feelings and emotions
and is a personal growth experience.  When I return home, my support system is:
12 Step Program______ Feelings Support______ Group______
Individual/group______ Church group______. Spiritual practices
group______ Other______.

Signature__________________________________________________Date______________


Make $600 deposit check out payable to AIA and send to: AIA c/o Barbara
K. Rector, 9852 E. Skyview Drive, Tucson, AZ  85748  USA    
Workshop deposits are non refundable and do apply to another AIA workshop.