Name *

Email *

Full Mailing Address *

Phone *

Would you like to be added to our email list? * Select ...YesNo

Occupation *

Birth Details (date, time, place) *

How did you hear about this training? *

Have you previously been standing or working in a shamanic or mediumistic tradition? * Select ...YesNoNo

Which one? *

Do you have a spiritual foundation in your life? * Select ...YesNo

Please describe. *

What is your current shamanic and/or mediumistic practice? Please describe in detail. *

Describe your relationship and current practice with MediumShip? *

Please describe your current relationship with your Helping Spirits. Feel free to be detailed. *

In the past, have you experienced any of the following: * Depression
Post traumatic stress syndrome
Dissociation
Panic or anxiety attacks
Chronic stress
Sleep disorders
Anger
Alcoholism / drugs
Compulsive behavior
Chronic illness
Negative self-talk
Sense of something missing
Shame
Procrastination
Mood swings
Paranormal experience
Chronic bad luck
Traumatic loss
None
Something else

Do you experience any physical or emotional challenges at this time? * *

Are you currently taking medications? If so, for what diagnosis? *

What draws you into this particular training? *

I agree to hold confidentiality throughout and beyond our meeting time: * Select ...YesNo

I understand that all payment are non-refundable and are a pre-requisite for registration to be processed * Select ...YesNo

Do you wish to share anything else?