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Qi Fit Qigong Program
Application Form

First Name

Last Name

Email

Phone

Which level are you applying for?

In-Person Level 1 - Wellness Certificate

In-Person Level 1 & 2 - Teacher Training

Online Level 1 - Wellness Certificate

Online Level 1 & 2 - Teacher Training

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Country

Date of Birth

Gender

How did you find out about Qi Fit Qigong Programs:

Facebook

Word of Mouth

Goggle Search

Instagram

Previous Student

Other

What was the name of the person who referred you?

Have you practiced Qigong or Tai Chi previously, if so how long and with whom?

What is your reason for wanting to learn Qigong or become a Qigong Instructor?

Where would you like to see your Qigong skills take you in the future - personally or professionally?

Thanks for submitting!
We'll be in touch shortly!

NICHOLAS BLEWETT

Dr Chinese Medicine/Acupuncture

Waterside Business Estate

Unit 17/2 Hawker Street

Currumbin Waters, Gold Coast

Qld 4220

p. 0433775488

Questions & Booking Requests / Enquiries.

Thanks for submitting! We will be in touch shortly!

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