Name: Level I | Three Day Seminar — Parts 1 & 2
Start: 2020-04-03T10:00:00-07:00
End: 2020-04-05T18:00:00-07:00
Location: IQ&IM Center for Education and Wellness

$25.00

Application to join the IQ&IM Qi-Energy Management Series.

Prerequisite for Series Application: Completion of all Yi Ren Qigong Foundation Levels I, II and III.

Non-refundable application fee is $25. Please fill all required fields to complete your application.

Personal Information
First Name *
Last Name *
Email address *
Phone Number *
Emergency Contact Information
Name: *
Relationship to You: *
Phone Number: *
Interest in the Qi-Energy Management Series
Why are you applying to participate in the Qi-Energy Management Series? *
Yi Ren® Qigong Training
When and with whom did you complete Yi Ren® Qigong Levels 1, 2 and 3? *
Have you completed or are you currently in the process of completing the Yi Ren® Teacher Certification Training Program? *	Yes No
Please list the Yi Ren® Qigong classes and/or seminars you have taken including year and Instructor. *
Personal Cultivation History
How long have you been practicing Yi Ren® Qigong? *
How often do you practice? *
How long do you typically practice? *
Please describe your personal Yi Ren® practice. How has your practice has evolved over time? *
Please write a few paragraphs about your internal cultivation realizations. How you have changed through your cultivation process? How has your life changed? *
Previous Training and History
If you have received training in other modalities such as yoga, meditation, tai chi, martial arts, etc., please list your trainings and indicate your level of training or certification, years of practice, current involvement and any other relevant information. *
If you have received medical/therapeutic training in other modalities such as a medical doctor, naturopathic doctor, massage therapist, Traditional Chinese Medicine, psychotherapist, energy worker, etc., please list your trainings and indicate your level of training or certification, years of practice, current involvement and any other relevant information. *
Do you have or have had any medical, physical, mental or emotional conditions that IQ&IM should be aware of that could affect in any way your program participation or your wellbeing or the wellbeing of other students participating in the Qi-Energy Management Series? If so, please describe. *
Is there anything else you would like to share about yourself or that would be relevant to your acceptance and participation in the Qi-Energy Management Series?
References
Please provide as specified below three personal references. For the Yi Ren Qigong references, if possible, please use people that are not current members of the IQ&IM Board and Staff.
Yi Ren® Certified Instructor
Yi Ren® Instructor Reference: Name *
Yi Ren® Instructor Reference: Email address *
Yi Ren® Instructor Reference: Phone number *
Yi Ren® Community Member
Yi Ren® Community Member Reference: Name *
Yi Ren® Community Member Reference: Email Address *
Yi Ren® Community Member Reference: Phone number *
Professional or Friend Reference
Professional or Friend Reference: Name *
Professional or Friend Reference: Email *
Professional or Friend Reference: Phone number *
Resume
Please upload your resume (as a DOCX or PDF file). Resume must be included for a complete application submission. *

Electronic Signature
Note: This item requires you to electronically sign an agreement. Please review the text and provide your name below.
Qi-Energy Management Series Agreement
I affirm that the information that I have submitted is true, correct and complete. I understand and agree that should my application for the Qi-Energy Management Series (QEMS) be accepted and I subsequently register for the QEMS, I am making a commitment to participate in the entire series and I am responsible for the entire series tuition should I choose to terminate, or IQ&IM terminates for cause, my participation in the QEMS prior to the series completion. IQ&IM reserves the right to discontinue my participation in the QEMS at any time for reasons including but not limited to a lapse of good standing, falsification of information or participation in acts of behavior contrary to the IQ&IM Yi Ren^® Student Participant Code of Ethics and Conduct: Professional Behavior: Maintain Professional Ethics and Student Confidentiality Maintain Compassionate Caring Behavior Maintain Respectful Communications Maintain Personal Health & Wellness Maintain Professional Boundaries Yi Ren Student Participant Code of Ethics and Conduct: Adhere to high standards of professionalism, integrity, and honesty. Respect the rights and properties of students, colleagues, and other professionals, and safeguard all confidences and privacy. Maintain appropriate personal and professional boundaries and recognize that it is unacceptable to manipulate the energy and consciousness of others. Refrain from any substance abuse and model the highest standards of healthy behavior. Strive to prevent passive reactive behavior and misuse of energies including mental, emotional, spiritual, and sexual energy, or any kind of abuse. Conduct oneself without favoritism, prejudice, or discrimination with regard to age, race, creed, color, national origin, sex, honorably discharged veteran or military status, sexual orientation, or the presence of any sensory, mental or physical disability. I understand and agree that should I participate in the QEMS, the information that is presented in the QEMS is for my personal use only and that nothing may be copied, shared or used by myself for anything other than personal individual use without the express written permission of IQ&IM and Dr. Guan-Cheng Sun, PhD. and that all written, recorded or electronic media materials of any kind prepared, made, distributed, developed or in any way provided whether through personal delivery or by electronic means in during the QEMS are restricted.
Signature: *

Personal Information

Emergency Contact Information

Interest in the Qi-Energy Management Series

Yi Ren® Qigong Training

Personal Cultivation History

Previous Training and History

References

Please provide as specified below three personal references. For the Yi Ren Qigong references, if possible, please use people that are not current members of the IQ&IM Board and Staff.

Yi Ren® Certified Instructor

Yi Ren® Community Member

Professional or Friend Reference

Resume

Electronic Signature

Qi-Energy Management Series Agreement