Group Work Request Form | Take Time to Breathe

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Corporate and Community Interest Form

Interest form for prospective corporate and community partners of Take Time To Breathe.

Company or Organization:(Required)

Representative/Contact Name(Required)

Position

Email(Required)

Phone(Required)

Multi-line address

Country/Region

Address

City

Zip / Postal code

Estimated the number of participants(Required)

Interface Type(Required)

In-Person

Virtual

Hybrid (both in-person and virtual attendance)

Unknown

Services of interest:(Required)

Keynote Speaker

Conference Presentation

Professional Development

Wellness Retreat

Community Class

Private Class

Other: Custom Workshop or Event _______________________________________________________________

Services of Interest: Check all that apply.(Required)

Anxiety and Stress Management

Migraine & Headache Relief

Tao Yin Yoga

Qi Gong: Emphasis Strength.

Qi Gong: Medical Emphasis

Meditation: UHT Inner Smile

Tai Qi Qi Kung: UHT 13 move form

Elusive Psoas, Balance. hips, core.

Spinal strength: nervous system

Inversions

K-12 Educator CE

NeuroFit

Other

We can tailor programs to meet your needs. Detail any specific requests you have.

Point of Contact: Signature 'I agree to be contacted for services requested' (Required)

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CONTACT

Email:

Phone:

deanna@taketimetobreathe.com

267-762-5850

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