Registration page

Registration page

Register

Event:

2023 October International Avatar® Course

Date:

30 Sep 2023 - 08 Oct 2023

Location:

Zoom

Do you want to register as student or master? if you are not sure then choose student.

Student

Master

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Please complete this form in English.
If you have questions about filling in this form, please send an email to: secretariaat@avatarcursus.nl

First name *

Family name *

Street address *

Zip code *

City *

State / Area

Country

Country of passport *

Telephone

Cellphone

Email *

Set password *

Add password message

Repeat password *

Are you 18 years old or older?

Older than eighteen

YesNo

Emergency contact name

Emergency contact phone

Relationship to you

What do you do for a living?

Languages (native and others, multiple entrees are possible)

Written materials language

Verbal translation from English needed

YesNo

Important information:

Please answer the following questions so we can be in the best possible position to support you.

1) Are you currently under any medical or psychiatric supervision (including psychotherapy or counseling)? *

YesNo

2) Are you currently taking any prescription or recreational drugs? *

YesNo

3) Have you ever received psychiatric and / or psychological treatment? *

YesNo

4) Have you ever been subject to traumatic injury or a violent attack? *

YesNo

Course

Select course parts you want to participate and days attending. Put any remarks if needed.

Full Course

Intern

Intern AI

Intern ReSurfacing

Intern Tweenie

ReSurfacing

Other

Part 2

Part 2 and 3

Part 3

ReS+Part 2

Review Full Course

Review ReS + Part 2, New Part 3

Review ReSurfacing

Review ReS, new Part 2

Review ReS, New Part 2 and 3

Provide your Master's email *

I do not have a master

Prices vary from country to country; ask your Avatar Master for the correct price.

A copy of this form will be sent to your Avatar Master.

Please arrange payments with your Avatar Master before starting the course or workshop.

I give permission for Star's Edge to use this information for my application for this course. I understand that Star's Edge may need to share some of this information with other organizations such as hotels and credit card processors to complete my application.

YesNo

User information

Name:

Address:

Country of passport:

Email:
Phone:
Cell:

Qualified master's name:

Qualified master's email:

My master course date:

Master id:

License

Currently licensed?

Valid till:

Are you 18 years old or older?:

Your age:

Guardian:

Relationship:

Emergency contact name:

Phone:

Relation:

What do you do for a living?:

Language:

Written material language:

Translation needed:

I can also translate in :

I am currently a(n)

Payments can be done to International Avatar Courses b.v. Amsterdam, account number IBAN NL67ABNA 062.19.89.835 BIC ABNANL2A.

Money owed

I have completed

This is my

I will bring this many students

1) Are you currently under any medical or psychiatric supervision (including psychotherapy or counseling)?

2) Are you currently taking any prescription or recreational drugs?

3) Have you ever received psychiatric and / or psychological treatment?

4) Have you ever been subject to traumatic injury or a violent attack?

I give permission for Star's Edge to use this information for my application for this course. I understand that Star's Edge may need to share some of this information with other organizations such as hotels and credit card processors to complete my application.

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