Student Questionnaire Select Options Confirm Options Checkout Receipt Questionnaire Please complete this questionnaire and then submit it by clicking on the submit button below. We'd like to receive the form sooner than later, as this form helps us to organize homerooms, plan for exceptions and preferences, and give you the best possible learning experience we can! Note that items marked with an asterisk must be answered or the form will not allow you to send it! Name* First Last Email* We will send you a letter with further details about the workshop. How would you like to receive it?*Email onlyUS mail only (I can't receive email!)Phone numberCellphone nunberWhich workshop are you attending?*MalibuNorth CarolinaI am a*MaleFemaleAge*Profession/Area of Study*Previous study of the Alexander TechniquePlease be specific so we can place you in an appropriate group. Are you an Alexander Technique Teacher or Teacher Trainee?NoTeacherTraineeYear CertifiedYears of Training CompletedOne (1)Two (2)Three (3)School where you trained or are trainingOther interestsFor example, fine arts, performance arts, athletics, martial arts, etc.Further CommentsAny more information about your condition, experience, etc. that will help us in working with you as a student. (Note: Do not include rooming, food, etc. requests--they have a space below)HomeroomYou will be assigned a homeroom teacher and class, with whom you will meet every day. The homegroups are assigned just before the workshop begins, and the information you provide here helps us to make the best groupings we can. You also will receive 3 private lessons. Although homegroups are assigned, you may request private lessons with teachers that you'd like to work with. Please make your requests below.Private Lesson RequestsYou will receive 3 private lessons throughout the week. If you have teacher requests for the private lessons, please list them here. We will try our best to honor your request.Special RequestsPlease add any additional information or special requests that would aid us in understanding your situation, placing you in a particular class or dorm room, addressing health concerns (injuries or illnesses), etc.:How will you be travelling?CarPlaneOtherUndecidedArrival Date Travel info is optional. If you send your itinerary details, then if you don't show up, we have some information about how and when you planned to travel.Arrival Airline and Flight No.Arrival Time : HH MM AM PM Departure Date Departure Airline and Flight No.Departure Time : HH MM AM PM Early or Late Arrival Comments If you plan to arrive a day or more early or leave a day or more late, please tell us what your plans are. How did you find out about the workshop?* From a friend Brochure Postcard Google, Yahoo, etc. online ad Online search Another website From my Alexander Technique teacher I already knew Other Who is your Alexander Technique teacher?On which website did you find us? Please elaborate on how you found the workshopNameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle AJAX powered Gravity Forms.