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Advanced Work Application Form

Please attach a photo (right side up) of just you, without your family, friends or pets. Thank you * (JPEG, 2MB limit)
Email *
Select the event you're
applying to *
First Name *
Last Name *
Preferred Name
Gender *
Date of Birth
(DD/MM/YYYY) *
Occupation/Profession *
Street Address *
Suburb/City/Town *
State/Province/Terr/Region
Postal/Zip Code *
Country *
Phone Number *
Emergency Contact Name *
Emergency Contact Phone Number(s) *
In what language(s) are you
fluent? *
English
German
Italian
Spanish
Portuguese
French
Hebrew
Greek
Other
If other was selected, which one?
Are you interested in receiving our newsletters via e-mail? *
Yes No
When and where did you do Path of Love? *
How did you hear about this workshop? *
Please list the personal growth work you have participated in including therapy groups, spiritual retreats and individual therapy. *
Briefly write about why you want to do this workshop? *
Do you have any physical disabilities or limitations? Please let us know of any health or medical issues that you feel it would be helpful for us to know about. *
Are you taking any prescription medication? Are you being treated or have you ever been treated for any mental or nervous condition that required taking medication? If so, please give details. *
(For residential retreats only) Do you have any special dietary needs (for example, gluten or grain free, vegan, no diary, etc.) Please be specific. *
Anything else you would like to share? *
I represent that all of the information provided in this Application is true and correct to the best of my knowledge, and is being relied upon by POL Global Foundation Ltd in deciding my acceptance into this Advanced Work process.
Please Note: As this form will only submit if all fields have been filled out, please make sure you have completed them all. If a question does not apply, you can write "Does not apply".

Thank you!
The Path Retreats Team

If you are still having issues submitting this form please email [email protected]

Signature

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