Application form - School Of Movement Medicine

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Journey of
Empowerment
Essentials of Movement Medicine
2015
with Susannah (all Modules) & Ya’Acov (Module 2 only)
Minimum Prerequisites:
25 hours of Movement Medicine or related work with a qualified teacher.
Residential at Rill Estate, Devon, UK
Dates 2015:
Module 1: 17th – 22nd March 2015 5 nights (these dates are different to the original printed programme)
Module 2: 10th – 16th June 2015 6 nights
Module 3: 6th October– 11thOctober 2015 5 nights
All modules start at 5.00 pm and end with lunch on the last day which will begin at 1.00.
Registration will be between 3.00 pm and 5.00 pm on the first day of each module.
Modules 1 and 3 will be led by Susannah alone and module two will be led by Ya’Acov and
Susannah together.
Please note that in Module 2 the focus will be The Alchemy of Stillness work that involves the
creation of a ‘temple’ of installations. These installations will form the bedrock of the
landscape we call The Alchemist’s Garden, in which we will spend the whole night in simple and
powerful ceremony to transform the heavy lead of the past into the gold of pure awareness in the
present.
Cost £2295 (including food & accommodation).
£125 discount for bookings made by 21 January 2015
Additional £175 discount for payment made in full at the time of booking for bookings
made by 21 January 2015. Total to pay with this option £1995
Booking Fee
£295 (£170 if booking made before Jan 21st) To be made within 7 days of being accepted
on the course.
Payment Schedule
Payment 1
Payment 2
Payment 3
£625 by Jan 21st
£750 by May 1st
£625 by Sept 1st
ACCOUNT DETAILS:
Account Name:
Bank:
Sort Code:
Account Number:
IBAN:
SWIFT Code:
Mr & Mrs Y M Darling Khan (Transfers Account)
Handelsbanken, 11 The Crescent, Plymouth, PL1 3AB
60-95-34
55374476
GB19HAND40516255374476
HANDGB22
Cheques: All cheques to be made payable to Mr & Mrs Y M Darling Khan and sent to
Nappers Crossing, Staverton, Totnes, Devon, TQ9 6PD.
Credit Card Payments: We accept both credit and debit card payments. Please phone 00
44 (0) 1803 762255.
PayPal: Please contact us if you would like us to send you a PayPal invoice.
Transferwise: An alternative way to transfer money that reduces bank charges if you are
sending money from outside the UK is to use the website TransferWise at:
https://transferwise.com/.
To use this method of payment, you will need to sign up by following the instructions on the
site.
Accommodation:
We allocate the accommodation on a first come first served basis. There are a few
upgrades available. All upgrade prices are per person for the whole course (for all 3
modules = 16 nights):
Cheaper En-suite Singles*
En-suite Singles
Cheaper En-suite Twin*
En-suite Twins
4 Bedded En-suite
Non-Ensuite Twin
Non-Ensuite Triple
£344.00
£472.00
£136.00
£216.00
£72.00
£72.00
£72.00
*Please note the Cheaper En-suite Singles and Twin Rooms are under the Kitchen. There are only
2 cheaper single room and 1 cheaper twin room and they usual get booked early.
APPLICATION FORM – Journey of Empowerment Essentials of Movement
Medicine 2015
Please complete this application form as fully as possible. Please note that this information is only
for those involved in running this workshop and will not be disclosed to any third party. Past
difficult history will not necessarily disbar you from taking part in a workshop.
Name: _______________________________________________Date of birth: ________M/F:____
Address: _______________________________________________________________________
Phone and email: ________________________
Prerequisites: Please list relevant workshops with dates/teachers’ names:
How long have you been studying Movement Medicine or related practice and with whom?
Are you currently taking any medication that will influence your participation in a workshop?
Please disclose any illnesses or impairments that might be relevant to your studies, and indicate the
adjustments that would assist you.
We offer a simple, balanced vegetarian diet at our workshops that contains no wheat, no dairy and
no sugar in all the cooked or prepared food. Our capacity to cater for individual diets is limited. Do
you have any specific food needs or allergies that would not be provided for in this diet? Please
specify. There will usually be a charge (typically £5 a day) for special diets. Please note: you
must tell us of any special diets at least 10 days in advance of the course beginning.
Do you wish to have a room upgrade? (see above for prices) If yes, please state choice:
Your reasons for wanting to take part in this workshop:
Anything else you would like us to know about you at this time in your life?
Have you read and do you accept the Booking Conditions pertaining to this workshop?
I am aware that this workshop involves intensive physical activity in which there is an element of
risk of injury. I take full responsibility for my own participation and physical, emotional and mental
well-being throughout this workshop. I also understand that I am participating in this workshop for
my own personal benefit and that this workshop does not equip or qualify me to teach any of the
material offered.
_____________________________________ SIGNATURE _____________________ DATE
BOOKING CONDITIONS
This agreement is between yourself and School of Movement Medicine.
Please note our booking conditions as these constitute the contract between us.
1.
Payment Terms
Payment. Payments should be made in accordance with the attached payment schedule.
Should any amounts not be paid by the due date, we reserve the right to treat the booking as
being cancelled and charge a cancellation fee as set out in paragraph 7.
2.
The Contract
The contract to provide the workshop shall be created upon our acceptance of your booking.
3.
What is included/excluded?
Included. Tuition by Ya’Acov Darling Khan on all the advertised days of the workshop and
Susannah Darling Khan on some selected days, Breakfast, lunch and dinner and
accommodation at Rill. Excluded. Any fees for special diets and any travel costs and any
room upgrade charges.
4.
Alterations
Where the arrangements and/or facilities such as the venue or the teacher are cancelled by a
third party, we will use all reasonable endeavours to provide a suitable alternative, but we are
not obliged and cannot guarantee to do so.
5.
Changes to Arrangement/Cancellation
Every reasonable effort will be made by us to adhere to the advertised arrangements and
confirm workshop arrangements, but we reserve the right to alter/omit those arrangements
should it be found necessary to do so and we shall have no liability whatsoever to you for any
such changes, save the refund of any monies not expended.
6.
Attendance
We expect all participants to attend all modules and all sessions.
7.
Cancellation
If any client wishes to cancel arrangements for whatever reason, the following cancellation
charges shall apply: 60 days prior to the workshop there is a cancellation charge of £95.
Within 60 days of the workshop you will be liable for the total cost of the cost of the course
unless we are able to fill your place in which case there is a cancellation charge of £150. You
are liable for the total cost of the course once it has begun.
8.
Liability
We do not accept any liability for any matter beyond our control and we will not in any
circumstances be responsible for any consequential or indirect loss that you or any third party
may incur such as travel or accommodation costs if a course is cancelled.
9.
Assignment
We reserve the right to assign the arrangements between us upon giving you notice in writing.
10.
Accident/Injury
You need to ensure that you are of a sufficient standard of fitness and ability to partake in the
workshop. Please speak to us if you are unsure about this. We will not be responsible for any
accident or injury (save where it can be shown it results from our negligence) and you should
take out your own insurance to cover this.
We cannot accept any responsibility for loss or theft of property or valuables whilst you
attend the workshop.
11.
Governing Law
The contract between us will be governed by the laws of England.
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