Name *

First Name

Last Name

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Telephone Number *

Country

(###)

###

####

I am applying as a *

certified Sheng Zhen Gong Teacher

Teacher in Training participant

Sheng Zhen Seminar attendee

When did you first start Sheng Zhen Gong? *

MM

DD

YYYY

Please check which of the following you've studied *

Gathering Qi and Awakening the Soul

SZ Healing Gong 1&2

Union of 3 Hearts and 9 Turns

Heaven Earth Gong and Heart Spirit as one

Heart Mind as One and Listening to the Heart

Have you met Master Li or Jing Li? *

Yes

No

Please share dietary information *

Regular diet

Vegetarian

Gluten/Wheat free

Dairy-free

Do you snore? *

Yep

Not that I know of

Are you *

Early to bed

A night owl