The Quantum Academies

NAME

TELEPHONE:

EMAIL:

CITY, STATE/PROVINCE:

IF YOUR PARTNER IS THE REGISTERED OWNER OF A BIOFEEDBACK DEVICE THROUGH THE QUANTUM ALLIANCE, PLEASE PROVIDE YOUR PARTNER'S NAME:

DO YOU HAVE A SCHOLARSHIP FOR TRAINING THROUGH THE QUANTUM ALLIANCE?

Yes
No

I HAVE READ THE BASIC NAVIGATION MANUAL A MINIMUM OF THREE TIMES:

Yes
No

THE DEVICE THAT I WILL BRING TO BEGINNERS TRAINING IS:

iNDIGO
SCIO
I Will Share an iNDIGO With My Partner
I Will Share a SCIO With My Partner
Other

I WISH TO REGISTER FOR THE FOLLOWING BEGINNERS TRAINING:

BEGINNERS: Redondo Beach, California Sep. 6 - Sep. 11
BEGINNERS: Redondo Beach, California Oct. 4 - Oct. 9
BEGINNERS: New Jersey/Philadelphia Area Oct. 18 - Oct. 23
BEGINNERS: Toronto, Ontario Nov. 1 - Nov. 6
BEGINNERS: Escondido, California Nov. 1 - Nov. 6

Cancellations with less than two weeks notice will be assessed a fee of $75. Failure to show up for the class to which you are registered without submitting a prior cancellation notice shall result in an assessment fee of $150.

I acknowledge and understand the Cancellation Policy

Survey Software by ActiveCampaign