APPLICATION - REGISTRATION FORM and PAY BY CHECK

Please print out and complete this form. Submit it, along with your Letter of Intent,  on or before April 1st to: 

Francie Shimaya, 5405 Salem Walk Dr., Austin, TX 78745
francieshimaya@yahoo.com     (512) 366-3224

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Name:     ___________________________________________________________________

Home Address:     ____________________________________________________________

__________________________________________________________________________

Country:___________________________________________________________________

Telephone Number: _________________________________________________________

Cell Number:   ______________________________________________________________

Email Address:    ____________________________________________________________

Website: __________________________________________________________________

Please check ONE:  I am applying as    

____ a Certified Sheng Zhen Gong Teacher                                                                  

____ a Sheng Zhen Teacher in Training

 ____ a Sheng Zhen Seminar Participant

For First, Second & Third time paricipants to TT

1. When did you first start Sheng Zhen Gong? ______

2.How long have you practiced Sheng Zhen Gong? ______

3. Who is your current Sheng Zhen Gong teacher?    ______________

4. Have you studied: 

  • Gathering Qi and Awakening the Soul? _____
  • SZ Healing Gong 1&2? _____
  • Union of 3 Hearts and 9 Turns? _____

     And either: 

  • Heaven Earth Gong and Heart Spirit as one? _____

                           Or : 

  • Heart Mind as One and Listening to the Heart? _____

5.  How many hours of classes/workshops have you attended, with 

Master Li Junfeng? ____ With Li Jing? ____ with a SZ teacher?____ on the internet/video? ____

6.  Have you met Master Li or Jing Li?   If yes, when?    ________________________________

7.  When and where was your first TT?  ____________________________________

8.  How many TT have you attended?    ____________________________________

For Teachers in Training Participants (non-certified):

9.  How many Sheng Zhen Gong classes are you teaching 

weekly?   ___________________

yearly?    __________________

10.  How many total hours of Sheng Zhen Gong teaching have you accumulated during the last 2 years?   ______________________________________________________

For Certified Teachers:

11. What year were you first certified as a Sheng Zhen Gong teacher?

12. How many TT have you attended since your certification?

13. How many hours of teaching have you done?  

14. How many weekend seminars have you taught?

15. What volunteer work have you done for SZ? 

Medical Questions:

1. Please list any medical problems or needs that we need to be aware of,

      ________________________________________________________________

     ________________________________________________________________

2. Please list any physical limitations.  __________________________________

        ________________________________________________________________

3. Emergency contacts (name and phone number). _______________________      

Please be self aware and mindful that this is a nine-day intensive. The training can be physically and emotionally challenging at times. If you have a serious medical condition (this is defined as psychological or physical), it is important that we know about it before hand. Please be advised that there is no medical staff on hand to handle emergencies, and all emergencies will be turned over to the appropriate local medical professionals. 

Thank you for your understanding.

My diet is:  VegetarianRegular diet     Gluten free     Wheat-freeDairy-free

Other dietary limitations:       __________________________________________

Do you snore?       Yes    No

Are you early to bed or a night owl? (Please circle one)

I wish to room with:   __________________________________________

                            with:   __________________________________________

_____  My first room preference for this training is:  Share room with 3 people and bathroom down the hall ($1950 per person)

_____  My first room preference for this training is:  Share room with 2 people and private bathroom ($2165 per person)

_____  My first room preference for this training is:  Single room ($2400 per person)

_____ I am enclosing a check, payable to International Sheng Zhen Society for  ________________________.

_____ I am enclosing a (LOR) Letter of Recommendation and/or (LOI) Letter of Intent

Mail to:

Francie Shimaya, 5405 Salem Walk Dr., Austin, TX 78745
francieshimaya@yahoo.com     (512) 366-3224