Facilitator Application

Application Form

* Indicates required field

Your name *

Email *

Current Location *

Tell us about yourself in a short paragraph. *

Are you working in an outreach setting? *

YES NO

What areas do you work? *

Do you have a movement practice? *

YES NO

What kind practice and how long? *

What is your profession? *

Any medical issues that we should know about? *

If you are a student, what are you studying? *

Where do you see yourself offering DYA? *

Other population *

How did you hear about DYA? *

Friend Online Worked with Shauna

Other *

Please attach a recent photo of yourself. *

Max file size: 20MB

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Refund Policy
Training payment is refundable, less a 10% administration fee, up to 15 days prior to the training.
No refunds will be issued after the 15 days, payment is transferable to another training within a year of cancellation.

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