PARTICIPANT INFORMATION:

Name of Participant: Street Address:

City: State/Providence:

Postal Code: Country:

Home Phone: Cell Phone:

E-mail Address:

Please Confirm E-mail Address:

 

WORKSHOP SELECTED:
(This form MUST be completed a minimum of 45 days prior to the preferred workshop)

Name of Workshop:

Preferred Workshop Dates: Alternate Workshop Dates:



SCHOLARSHIP REQUEST:
Soltura has a limited amount of scholarship funds available to assist those for whom payment presents a hardship. These funds have been contributed by former workshop participants who want to help make the Soltura workshop experience available to more people. As these funds are limited, we need to know some information about you and your financial situation.

Occupation:

Employer:

What amount can you pay?

Scholarship Amount Requested:

How did you hear about Soltura?

Are there any special circumstances that may help us understand the need for a scholarship?

Do you know anyone who has participated in a Soltura workshop? If so, please tell us who and what he or she said about the workshop:

Why do you want to participate in a Soltura workshop?

Tell us about yourself - not "what you do" or "where you live", but WHO you are. Write a short personal essay that will help us understand a little about you and your motivation for self-exploration and growth.