Event Application

Workshop Application

Fill out this form with the details of your Esalen Massage education or training event.

ALL FIELDS ARE REQUIRED*

First name *

Last name *

Email *

Phone number *

Workshop Information

Teacher Names & Training Background *

Has this course been approved by the EMBA before? When? Leader? *

Have You Led This Course Before? *

Workshop Title *

Max # of Participants *

Student to Teacher Ratio*

Beginning, Intermediate, Advanced ? *

Format *

Total Fees per Student in $USD *

Additional Fees per Student in $USD *

Do you offer Payment Plan or Scholarship? Explain *

Start Date *

End Date *

Instruction Hours *

Will Workshop Attendees Be Staying On-Site *

If another teacher is presenting courses in this area: What is teacher’s name, when did you speak with them, and what was the response? *

Please list each teachers specific time contributions to this course * (Required for Auditing Purposes)

Complete Workshop Description * (As Marketed and Communicated to Attendees)

Student Admission Requirements and Prerequisites *

Location Information

Venue Name *

Venue Website *

Venue Contact First & Last Name *

Venue Contact Email Address *

Venue Phone Number *

Venue Facility Type *

Venue Physical Address *

Country & Region *

Additional Venue Information or Contacts *

Will you use student teachers, translators, or assistants? How many will you use? What are their qualifications and experience? *

Workshop Marketing Information

Workshop Registration Link *

Website Marketing Link

Teacher Website Link

Social Media Link

How is this Workshop going to be marketed? And through which channels? (e.g. Website, Email, Social Media, Print, Advertising) *

Workshop Syllabus and Curriculum

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Marketing Material

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Workshop Agreement

I assume any and all liability for this course and will adhere to all of the corresponding EMBA Ethical Standards of Practice.
I will submit roster contact information to EMBA office after course completion, or after first segment of a certification.I have read, understood and applied the correct use of the Esalen® trademark as referenced in the Trademark Use Guidelines Agreement.

WORKSHOP FEES & TEACHER MATRICULATION

All applications are kept in Esalen Massage files for reference.

In case of changes, re-submit to this application with the most current information.

Upon submission a copy of this application will be sent to your email.
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