1. There is a time, place, and experience
that filled you with a sense of accomplishment....pride.....empowerment. Describe this
event - the who, what, where, when and why's:
2.There is a moment in everyone's life when they felt
assured, self-confident, and secure. Describe this and give a sense of the surroundings,
(physical environment) and the key person(s) involved:
3.What is your memory or fantasy of complete and total
emersion into relaxation...where are you - and try to be aware of the sights, sounds,
smells and touch that make up this vision :
4.What is your favorite color.... what feeling does it
evoke:
5. Which is your most highly developed sense...(smell,
sight, taste, hearing, touch) :
6.Do you consider yourself intuitive, analytical, reactive,
creative, or concerete in the way you think through most problems. ( A general sense of
your thinking style is what is being asked):
Please fill up the shipping address below:
First Name:
Last Name:
Street Address 1:
Apartment#:
City:
State/Province:
Zip/Postal Code:
Country:
Phone:
Fax:
E-mail:
Please fill out the form below with your credit card
information:
Card Number
Name on Card
(name as it appears on the card please)
Expiration Date Card Type
Address
City State Zip/Postal Code
Country
(Statement address - where the statement of the card is actually mailed to)
Thank you!