CE & CE-RELAX Session Sign-up Form

It is my own decision to attend the CE session.

If you are submitting this checklist on behalf of another person, please reflect their response as accurately as possible.
Representative’s name:
*Please check to indicate that you have read this check item, even if you are not representing others.

I understand that my reservation is not confirmed until I make a payment.

I will come at the scheduled time. I understand that I cannot attend the session if I am late.
*Please contact us promptly if you get lost.

I understand that you will be using high quality auditory displays (headphone system); therefore, I need to remove earrings and/or makeup around my ears and refrain from using any hair spray before the session.
*See FAQ for more details.

I will come well rested with no stress.
*Not too full and not too hungry is the best condition to take the session.

Have you ever listened to the Currell Effect CD in the past?
Yes　 No
If yes, please be sure to describe your experience.

Have you ever attended the Currell Effect or CEX session(s) in the past?
Yes　 No
If yes, please be sure to describe the numbers of session(s) you took and your experience(s).

Have you ever meditated in the past?
Yes　 No
If yes, please be sure to describe the type of meditation you do and your experience(s).

It is very important that your mind is clear upon taking the CE session.

NOTE: Please be aware that the following could result in reducing the CE effect.

If you are:
Not well rested, have stress, under the influence of alcohol (drinking alcohol within the last 24 hours), on drugs or medication such as painkillers, depression, physical pain, have a present time problem that distracts you from focusing during the session, anything that could dull the clarity of your thinking process, or anything else that prevents you from being stable both physically and mentally that could cause the mind and body to not process data received properly during the CE session.

IMPORTANT!!
For those who have a history of having epileptic seizures or similar symptoms or illnesses, research has shown that sound could trigger such seizures. The Currell Effect is a very powerful sound session, so individuals that exhibit these symptoms cannot take the session.

Please also read the FAQ regarding the “Check Sheet” and “headphones and eye mask.”

If you have a hearing problem, or a problem about wearing headphones and/or eye mask, please contact TT Office.
tt_office@ishwish.net

I hereby acknowledge all the checked items above and certify that I have answered truthfully.

Last Name*

Mobile Phone*

E-Mail*

Address 1*

Address 2

City*

State/Prefecture*

Zip code*

Membership Fee: Free
Benefits: Discounts on seminars, workshops, events and concert by Christopher Currell and CE session.

CE member: You may signup for a CE membership upon making a reservation for a CE/CE-HD session.
More information about CE-RELAX

Please let us know where you heard about the Currell Effect.*
(Select one. If more than one, select Others.)

From friends/acquaintance
      Referral by:
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