Please fill out the form to complete your Reset registration.

Institution Name

Location for Workshop

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Contact

First Name

Last Name

Email Address

Phone Number

Alternate Contact Name

First Name

Last Name

Email Address

Phone Number

Occupation of Atendees

What is the reason for requesting a Reset session?

In your own words, please describe what has led to requesting a Reset workshop. This can include information about the workplace/classroom environment, stress, symptoms or complaints by employees/students, etc. Please paint a picture as best you can.

What is the biggest concern regarding your reason for requesting a Reset session? *

Has it affected productivity, focus, team camaraderie, happiness ... ?

What are the goals for your Reset workshop and Self-Tuning Kit?

Please check all that apply.

Team building

Stress relief

Balance

Flexibility

Address a specific pain or discomfort

Increase focus

Employee Longevity

Less workers' compensation claims

Other Goals

Do you know of any health concerns or limitations that might affect attendees during a Reset workshop?

What is the age range of attendees?

Please list anything else we should know that would help create your kit.