Choose Program Info

Program Name

Program Date

Your Info

First Name

Last Name

Nickname

Date of Birth

Address Line 1

Address Line 2

City

State

Country

Postal Code

Primary Phone

Secondary Phone

Email

Occupation

Emergency Contact Name

Emergency Contact Phone

Have you participated in any other mind training activities? (TM, Silva, Monroe, etc.)

Have you listened to any Hemi-Sync® or SAM audio exercises?

What specifically about this program motivates you to attend, and what benefits do you hope to receive?