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First Name *

Last Name *

Profession / Qualification

Email *

Years in Practice

0–2

3–5

6–10

10+

Which Immersion location are you applying for? *

London – June

Gold Coast – September

Melbourne – October

Other

What country do you want an immersion experience?

What feels most challenging in your current practice when working with female patients?

Why does this immersion feel important to you right now?

Which Immersion experience are you interested in? *

Female Fundamentals Immersion ($4,995)

Female Fundamentals Inner Circle ($6,599 – limited availability)

Are you comfortable with the investment range outlined above? *

Yes

I would like to discuss payment plan options (Immersion only)

Agreement Checkbox *

I understand this is not a nationally accredited certification.

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