Cracking the Matrix Code Workshop

Thank you for registering for the first ever Cracking the Matrix Code Workshop!

The workshop will be:
Friday, May 20, 7:30pm – 11:30
Saturday, May 21 10:00 am – 11:00pm
Sunday, May 22 1:30pm – 6:30
in beautiful Norman, Oklahoma

Please make your payment through Paypal first,
then fill out the form below.

If you have any questions, please send me an email & I'll get back to you asap!

Hacking the Matrix Code Workshop Registration

Please note that all fields followed by an asterisk must be filled in.

First Name*

Last Name*

E-Mail Address*

Web Site URL

Street Address*

City*

State/Prov*

Zip/Postal Code*

Country*

Home Phone*

Business Phone

The 2 meals provided will be vegetarian. Do you have any food allergies or sensitivities?

	Yes
	No

Please list any food allergies or sensitivities:

Age Range (please select one)

	18 - 34
	35 - 50
	50 - 70
	71 & Over

Have you attended other Personal Development Workshops or Training Programs in the past?

	No, this is my first.
	Yes, I have done 1 or 2.
	Yes, I have done several workshops or training programs.
	Yes, I am a personal development junkie.

Please check all you have experience with:

	Abraham-Hicks
	A Course In Miracles
	Astrology & Tarot
	Buddhism
	Hermeticism
	Jane Roberts/Seth
	Kabbalah
	Hinduism/Advaita
	Landmark or EST
	Mystic Christianity/Holy Grail
	Nondualism (Robert Scheinfeld, Jed Mckenna, etc.)
	Quantum Physics & Speculative Science
	Shamanism & Entheogens
	Sufism
	Theater & Acting
	Urantia Book
	Wicca or Paganism
	Writing Fiction

Any other trainings or schools of thought not listed above?

We will be venturing into deep waters, challenging our assumptions, habits and beliefs. Is there some related area or topic which you would like to address at this workshop?

Is there anything else you would like me to know about you?

I understand that this workshop will be dealing with emotional and possibly past traumatic issues. I understand that I may find the exercises and ideas challenging to my established beliefs about myself and the world. By clicking "Yes," I am acknowledging the possibility of upsetment and my willingness to take personal responsibility for dealing with my personal issues. I further acknowledge that the issues and ideas raised in this workshop could likely continue to impact me over time, and will not hold Dara Fogel responsible for any negative results. If I need help, I agree to seek out appropriate assistance.*

	Yes, I agree.
	No, I do not agree.

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