Event Application

Workshop Application

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

REQUIRED FIELDS ARE INDICATED WITH AN ASTERISK *

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)

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

Student Admission Requirements and Prerequisites

Location Information

Venue Name

Venue Website

Venue Country & Region *

Additional Venue Information or Contacts

Workshop Registration Information

Please provide either a url or an email address for registration. A url will link prospective participants directly from the EMBA website to your workshop's online information/registration page.

Workshop Info / Registration Link

Workshop Registration Email

Teacher 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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