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doc - Innersource Presents - Powerful Programs for Freeing Body

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doc - Innersource Presents - Powerful Programs for Freeing Body ...

    ENERGY MEDICINE FOR WOMEN

    (And the Men Who Love Them)

    Sponsored by the Association for Humanistic Psychology in collaboration with Innersource.

    Donna Eden with David Feinstein, Ph.D., and Teaching Staff

    Two Classes Over Four Days

    November 7 - 8; and 9 - 10, 2009

    THE WIGWAM GOLF RESORT & SPA

    PHOENIX, AZ

Energy Medicine 101: Two days of training in the essentials of energy medicine. This is a

    prerequisite for the course, below, if you have not taken any other classes with Donna.

    Cost: $250. November 7 & 8 (Saturday & Sunday) 9 a.m. 5 p.m. 12 CEs available

Energy Medicine for Women: This class focuses on a woman's biological process from her first

    menstrual cycle through menopause, her "second prime of life." Among the issues addressed will

    be the energies associated with PMS, fertility, sexuality, pregnancy, birthing, and the challenges

    and gifts of coming into the wisdom years. For each topic, the class will provide understanding

    along with enormously practical and effective techniques for navigating your way.

    Cost: $250. November 9 & 10 (Monday & Tuesday) 9 a.m. 5 p.m. 12 CEs available

    Special Pricing

    Take both classes for $399

    (a savings of $101)

When: November 7 10, 2009 (Saturday - Tuesday)

    These dates reflect both workshops. Registration for each workshop begins at thth8:00 a.m. on the 7and 9, respectively. ththEach workshop will be over at 5 p.m. on the 8 and 10, respectively. Where: The Wigwam Golf Resort & Spa

     300 Wigwam Blvd.

     Litchfield Park, AZ 85340 (near Phoenix)

     (623) 935-3811

     Website: www.wigwamresort.com

    NOTE: If you are planning to arrive earlier or stay later than the workshop dates, please fill

    out the information on the bottom of the registration form. We will make the reservations for you,

    which will get you the conference rate. When you check out of the hotel, you will pay the hotel directly

    for all nights of your stay. Once our block of rooms is sold out for any shoulder dates, the hotels’

    regular rates will apply.

Accommodations: We have arranged a block of rooms at the Wigwam Golf Resort & Spa at the amazing

    rate of $72.00 per person, per night (plus taxes), double occupancy. The room block will be held for Innersource up to one month before each class. You must register through Innersource by filling out the registration form and we will make your room reservation for you. It’s first-come, first-

    serve so the earlier you register the more likely it is that you will get one of our rooms at the Wigwam.

    Once our block is full you are responsible for arranging your own lodging.

    If you have someone to room with, please be sure to write that person’s name in the space provided on

    the form. If you do not have a roommate, we will put your name in the divine lottery and pair you up with

    someone.

    VERY IMPORTANT!!! Innersource will make your hotel reservation for you, but you will pay

    the hotel directly at check out. Do not include the price of lodging on this registration form.

    The prices below are for your information only. However, we still need you to check off your

    rooming preference (shared or private), your arrival/departure dates, and the name of your

    roommate, if you have one, so that we can make your reservation properly. PLEASE DO NOT

    CALL THE HOTEL TO MAKE RESERVATIONS. IT MUST COME THROUGH INNERSOURCE.

    CUT-OFF DATE FOR HOTEL RESERVATIONS IS OCTOBER 1, 2009!

    HOTEL AMENITIES: High-speed internet access, private patios, oversized tiled bathrooms with private vanity

    area, deluxe Gilchrist & Soames toiletries, imported Italian bed linens, walk-in closets, terrycloth bathrobes, hair

    dryers, iron and ironing board, in-room safe, flat screen cable TV with remote, in-room movies and video games,

    Bose CD clock radios, coffee maker. The hotel is approximately 15 miles away from Sky Harbor International

    airport (Phoenix).

    NOTE: You are responsible for your own transportation and meals. Room prices are subject

    to availability.

$72.00/night - Shared Room (price does NOT include hotel taxes). You will pay the hotel directly at check out.

    $144.00/night - Private Room (price does NOT include hotel taxes). You will pay the hotel directly at check out.

    ******************************** MEAL PLAN - Optional

    $122.00/workshop The meal plan will cover 2 breakfasts and 2 lunches for each workshop, beginning

    with breakfast on Saturday and ending with lunch on Tuesday. If you attend both workshops, the meal package is $244.00. Dinners are on your own. You can have your choice of breakfast in either the Arizona

    Kitchen or the Grill (both located on site). Lunches will be served buffet-style with the entire group

    (location to be announced at class). This price includes all tips and taxes!!! We encourage you to sign up

    for the meal plan as it is a great way to meet and socialize with others in the class and to network.

    *********************************

    CUT-OFF DATE FOR HOTEL RESERVATIONS IS OCTOBER 1, 2009!

***Due to our commitment with The Wigwam Golf Resort & Spa, room reservations must be

    secured one month in advance. Any cancellation in a room reservation made with less than one

    month notice will result in Innersource having to bill you the amount equal to one night’s

    stay.***

    CE Information

AHP (Association for Humanistic Psychology) has been approved as a provider of Continuing Education Credit

    by the organizations or Boards listed below.

    California LCSWs & MFTs: Course meets the qualifications for continuing education credit for MFTs and/or LCSWs as required by the California Board of Behavioral Sciences, provider number PCE 604. 12 contact hours per class.

    Counselors: AHP is recognized by the National Board for Certified Counselors (provider #5360) to offer continuing

    education for National Certified Counselors and adheres to CEC guidelines. 12 contact hours per class.

    Nurses: Provider approved by the California Board of Registered Nursing, Provider #CEP8738. 12 contact hours per

    class.

    Social Workers: The State of Illinois Department of Professional Regulation for Registered Social Workers, license #159-000118. 12 contact hours per class.

Innersource is approved by the following organization as a provider of Continuing Education Credits:

    Massage Therapists: NCBTMB (National Certification Board for Therapeutic Massage and Bodywork) for Continuing Education credits - 12 contact hours per class.

If you sign up for CEs, there will be a CE table at the workshop where you will need to sign in each day in order to get

    your certificate at the end of the workshop(s).

Cost for each of these Continuing Education Credits is $20.00 per class (you must sign-up in advance

    on the registration form).

Airport Information:

    Sky Harbor International Airport is the closest airport to The Wigwam Golf Resort & Spa,

    approximately 15 miles away. Ground Transportation

    All major car rental companies service Sky Harbor International Airport. Guest transportation is available

    through various taxi and shuttle van services.

    You can also use the Super Shuttle at the Sky Harbor International Airport. The cost is $24.00 each way;

    however, if you register online using the coupon that can be obtained from us, you can receive $4.00 off

    the round trip price. Please contact Eric Stahlman at ericwithinnersource@yahoo.com if you’d like a shuttle

    coupon. Prices subject to change without notice.

    ***You are responsible for making your own transportation reservations***

    Directions to The Wigwam Golf Resort & Spa

From the East:

Take I-10 West and merge onto Loop 101 North. Travel approximately 5 miles to Camelback Road, exit 5.

    Turn left on Camelback Road, travel East for 5 miles to Litchfield Road, and turn left. Make the first left

    onto Bird Lane, then the first right onto Old Litchfield Road. Drive south to Wigwam Boulevard, turn left on

    Wigwam Boulevard and turn left again into The Wigwam Golf Resort & Spa.

    From the North:

    Take Loop 101 South to Camelback Road, exit 5. Turn right on Camelback Road, travel East for 5 miles to

    Litchfield Road, and turn left. Make the first left onto Bird Lane, then the first right onto Old Litchfield Road.

    Drive south to Wigwam Boulevard, turn left on Wigwam Boulevard and turn left again into The Wigwam

    Golf Resort & Spa.

    From the West:

    Take I-10 East and merge onto Loop 101 North. Travel approximately 5 miles to Camelback Road, exit 5.

    Turn left on Camelback Road, travel East for 5 miles to Litchfield Road, and turn left. Make the first left

    onto Bird Lane, then the first right onto Old Litchfield Road. Drive south to Wigwam Boulevard, turn left on

    Wigwam Boulevard and turn left again into The Wigwam Golf Resort & Spa.

For more driving directions or to download a map, please visit:

    http://www.wigwamresort.com/map-directions-fact-sheet.html

    ***You are responsible for making your own transportation reservations***

Note: You will have an opportunity to purchase our videos and other products at a discounted

    price during our workshop. The discounted price will ONLY be offered at the workshop

    it is NOT available prior to the workshop.

Please keep this information handy so you can refer back to it once we get closer to the

    workshop date.

    Everyone will receive a Certificate of Completion from Innersource.

    INNERSOURCE

    777 East Main Street

    Ashland, OR 97520

    Phone: (541) 482-1800 Fax: (541) 488-1739

    energy@innersource.net www.innersource.net

    EM 101 & ENERGY MEDICINE FOR WOMEN

    (Two classes over 4 days)

    NOVEMBER 7 10, 2009

Name _____________________________________________________________________

    Address ___________________________________________________________________

    City _____________________________________ State ________ Zip ________________

    Telephone _____________________________ Email ____________________________

    Signature:_________________________________ Date:____________________________

    By my signature I affirm that I have read and agree to the cancellation policy and release agreement that follow this form

    and that are posted on the Innersource website.

     Visa MasterCard Amex Discover

    $_________ Full payment Card #:__________________________________

     - ________ Deposit Expiration date:_______________

    $_________ Total Still Due ___ Check enclosed

    To register, complete the registration form and send full payment, or $100 deposit to reserve your

    space, to the Innersource address above. We accept VISA, MasterCard, Amex, and Discover.

    ___ $250.00 Tuition for Energy Medicine 101. Add $122.00 for meal package. ___ $250.00 Tuition for Energy Medicine for Women. Add $122.00 for meal package. ___ $399.00 Tuition for both classes. Add $244.00 for meal package.

    $20.00/class CEs. ____ AHP and/or ____ NCBTMB Add $20.00 for 1 class; $40 for 2 classes. ___ Special Needs (handicapped room, etc.) please specify:_____________________________

    ___ Shared Room ($72.00/night price does not includes hotel taxes). You will pay the hotel directly at check out.

    ___Roommate by Divine lottery unless you specify a roommate here:_____________________________

    ___ Private Room ($144.00/night price does not includes hotel taxes). You will pay the hotel directly at check out.

    ___ I have made other accommodations for lodging and do not need hotel reservations at the Wigwam.

    ***Arrival date at hotel: ___________________________

    ***Departure date from hotel: _______________________

    *Balances are due by 10/1/2009. If you paid your deposit with a credit card, we will automatically run

    your balance due on this date, unless we hear otherwise from you.

    Prerequisite met for EMFW class? Please tell us how you’ve met the prerequisite:___________________

    Please tell us how you heard about us by circling one of the choices below:

    Innersource Website Other Website Innersource Email Friend Evening Class Weekend Class

    Mailer________________ (enter priority code) Advertisement_______________________ (specify which one)

    A completed and signed registration form is required in order to attend these workshops.

     CANCELLATION POLICYCancellations may be made up to 60 days prior to the class and a full refund will be provided,

    less a $20 administrative fee. For cancellations between 30 and 60 days prior to the class, $100 cannot be refunded.

Due to commitments we have to make well in advance to the conference center and others in

    planning events, no refunds can be made for cancellations received within 30 days of the

    event. Any cancellation in a room reservation made with less than one month notice will result

    in Innersource having to bill you the amount equal to one night’s stay, per our agreement with

    the hotel. In situations involving illness or family emergencies, Innersource may, at its discretion,

    apply the tuition portion (but not the room & board portions) to a future event that is sponsored

    directly through Innersource.

Cancellations must be received in writing or by e-mail (info@innersource.net) and will be

    promptly acknowledged once received.

    Innersource Release Agreement

I understand that Energy Medicine is an innovative approach to health care, which is only beginning to be

    investigated scientifically. I further understand that the training in Energy Medicine and other services I

    am or may be receiving from Innersource do not substitute for diagnosis and/or treatment from a

    qualified health practitioner for illnesses, injuries, or other medical conditions.

I understand that some classes are videotaped, that these recordings may be distributed for educational

    purposes, and I give my permission for my participation to appear on these recordings. Video recording,

    without explicit permission from Innersource, is not allowed.

Innersource staff reserves the right to prevent anyone from attending a class as it deems appropriate, or

    to require anyone to leave a class, as it deems appropriate, refunding only the prorated portion of the

    tuition not used.

This class may use banquet tables for you to lay on as a partner works with you during some of the

    practice sessions. This is basically a safe and sound practice that has been employed in the past by us, as

    well as by many other groups that teach healing procedures.

However, because it is a non-standard use of the tables, the hotel requires a statement that releases

    liability. More importantly, to avoid any possible mishaps, it is ultimately your responsibility to insure that

    the table is set up correctly (that the legs are secured) and that the table is not damaged. Please be sure

    it can bear your weight by sitting on it first to test its ability to support you before committing yourself to

    lying down on it.

    By signing this form, you agree to assume full responsibility for your safety in using a banquet table for practice sessions. You agree to take the precautions described above and will not hold Innersource, any of

    its employees, associates, or contractors, or any hotel Innersource works with, liable for any mishaps that might occur as a result of using banquet tables in this manner

I also understand that any activity in which a person might participate involves some risk. In consideration of being

    permitted to enroll for the instructional and other services offered through Innersource, I release and hold

    Innersource, its agents, officers, employees, directors, successors, and affiliated corporations harmless, unless gross

    negligence can be demonstrated, from any claims arising out of my participation in the instructional or other services offered by Innersource or the use of facilities and/or equipment it provides.

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