First Name _______________________________ Last Name ______________________
I am male ____ female _____ * Birth date: Month ________ Day ________ Year
I am: ___ Single, ___ Married,
___ In a Relationship, ___ Partnered but attending
this event as a single
I need help with: ___ Tuition, ___ Transportation,
___ Meals, ____ Accommodations
estimate my total expenses will be: $_________________
I can contribute $__________ towards my expenses
Choose a nickname or pseudonym _______________________________
I wish to use my ___ real name, ___ nick name in
class and at events
Email _________________________________ Telephone: Home
Work Phone: (____)_______________________ Cell Phone:
Address: Street _________________________________ City:
State/Province: ___________________________ Zip: ______________ Country:
If visiting Maui, how long will you be on island? _______ I live on Maui ______
full time, _____ months a year
I visit Maui ______ times every _______ years for _____ weeks or ______ months
______ I verify that I am at least 18 years of age*.
*(You must be 18 or older. Positive ID showing proof of age is required). Please
send copy of proof of age)
1. Are you a current School of Tantra, World Polyamory Association or World
Tantra Association Member?
If so, when did you
What's your registration number? _________
When does your membership expire? __________
2. I am (pick the ones that best describe you):
_____ Curious about the lifestyles
3. What would you like best? (If more than one apply, number in order of
_____ committed relationship one on one
_____ committed relationship polyamory (more than one)
_____ community - non sexual
_____ community - sexual
_____ discreet affair
_____ group marriage (many people committed to each another)
_____ group sex
_____ intimate network (group of lovers that all know one another or know of one
_____ line marriage (committed group, all ages)
_____ living alone
_____ living together
_____ menage a trois (three way lovemaking)
_____ monogamy (married to one person)
_____ mono-poly (polyamorous couple who live together, date others as a pair)
_____ one on one sex
_____ playcouple (committed couple who play sexually with other singles and
_____ polyandry (one woman, many men)
_____ polyamory (loving more than one in an intimate relationship)
_____ polygamy (one man, several women)
_____ polyfidelity (closed circle of sexual intimacy)_____ open relationship
_____ open marriage (married to one person, dating outside of marriage)
_____ serial monogamy (dating one at a time, for a limited time)
_____ single and dating (one person at a time)
_____ single and dating (more than one person at a time)
_____ swinging/lifestyles (sexual episodes)
_____ tantra/tantric (sacred sexuality)
_____ triad (committed threesome)
_____ other (please explain) ____
4. Do you have any experience with tantra? polyamory?
5. If so, please describe.
6. What attracts you to our school, workshops, conferences or events?
7. Do you hope to find a date, mate or connect with someone at school or events?
8. I am seeking: ___ single man; _____ single woman; _____ couple; _____ triad;
_____ foursome; ______ group
9. What is your current relationship status?
10. Are you happy?
11. If not, what keeps you from your happiness?
12. Are you and your partner sexually active?
13. If not, please explain why you are not _____________________
14. If you are sexually active, how often do you have sex?
15. How often would you like to have sex?
16. Are you happy with your sexual drive?
17. If you could change it, what would you change about your sex life?
18. I want to be involved with my partner: _____ full time, ____ weeks or _____
months a year
19. What are your attitudes toward nudity?
20. Would you be a) comfortable or b) uncomfortable with optional nudity at a
seminar or event you might attend?
21. What are your attitudes towards sexual behavior, orientations or
relationship structures different than yours?
22. Do you have children? ____ If so, how many? ______ Are they grown? _____ Do
they live with you? __
23. Do you want children _____ If so, how many children do you want?______
24. Do you have pets? _____ If so, how many? ______ What kinds of pets?
25. Do you want pets ? ______ What kind of pets do you want? _____________ How
26. Who was in charge of you when you were little?
27. If you were raised by a single parent, how did that affect you?
28. What did you lack in a parent that you would like to find in a lover?
29. How many siblings did you have?
30. What was your place in the birth order?
31. How did your place in the birth order affect you?
32. Describe the model of relating your parents showed you. What did you think
of your parents and the way they modeled relating? Of what they showed you, what
would you like to keep, discard or modify?
33. Describe two critical events in your growing up that affect you to this day.
What was the cumulative effect of your childhood on who you are now?
34. Describe two peak events from your past. What affect, if any, do they have
on you to this day?
35. What are the different roles or aspects of your personality that you must
36. What were the religious or spiritual practices that you were taught when you
37. Did you follow those practices or rebel against them?
38. What are your religious and spiritual beliefs and practices now?
39. How do you follow your religious and spiritual practices?
40. Describe your physical appearance. Attach photos, several if possible, to
show your many moods.
41. Height ____________ Weight _____________ Body Type ____________
42. What else would you like to tell us about your physical self:
43. Describe your Personality:
44. What are your best qualities?
45. What are your faults?
46. Are you a jealous person? If so, how do you handle jealousy?
47. If not, how did you learn not to be jealous?
48. If you are, describe an incident where you were jealous
49. How did you resolve your jealousy?
50. What are your interests?
51. Do you read? If so, what are your favorite books?
52. Do you watch television? If so, what are your favorite shows?
53. Do you like movies? If so, what are your favorite movies?
54. What do you seek in relationship?
55. What do the people you want to be with look like?
56. What are their qualities?
57. What are their interests?
58. What do you do when you notice someone that youíre attracted to?
59. If everything turned out the way you wanted, what would that look like?
60. List and describe six of the most important sexual and/or intimate
relationships in your life. How did you meet? Did you fall in love? How did you
part? Are they still with you? What affect did they have on you? What decisions
did you make based on your experience with them? How does that relationship
still affect you to this day?
61. Describe your current sexual or intimate relationships:
62. What other questions would you like us to ask you?
63. What else would you like to tell us about yourself?
interested in: Tantra Education, events, conferences, workshops, seminars or groups that
___ Morning ____ Afternoon ___ Evening
___ All Day Events
___ Two Day Events
___ Weeklong Events
___ Certification Programs
___ Group Events
___ Private Sessions
An orientation interview is required before admission to any of our
programs-groups, classes or events. Annual School of Tantra Membership Fee
is $150 which includes your application review and orientation interview or
private tutorial (see list below). If your total for programs is over
$500, orientation interview is free. The following private tutorials serve
as substitutions for your orientation interview
___ Annual Life Review and Introspection
___ How to Really Love A Woman
___ How to Really Love A Man
___ Orientation Interview
___ Tantra 101 (Tantra Basic Training)
___ Polyamory 101 (Polyamory Basic Training)
Please complete a
to register for events or classes. Send completed forms to
the address at the end of this form.
Date/Time I want my appointment _________________ AM/PM
____ Phone, ___ In Person
___ Group Orientation: Friday, 5PM.
I want to attend my interview:
___ by myself
___ with ________________________ (name of person)
Payment: Check ____ Money Order ___ Master Card ___ VISA ___
Credit Card Number _______________________ Expiration Date _________
Signature _____________________________________________ Name on Card
Master Card, VISA accepted, check or money order accepted. Mail this form along
with your information and payment to the address below so that we may review it
before your appointment. Call 808-244-4103 to schedule your appointment. If you
want to be included in our DATING BOOK for review by other members, send one to
five photos with your completed application.
SCHOOL OF TANTRA, 1371 Malaihi Road, Wailuku, Maui, HI 96793, 808-244-4103
web site: www.schooloftantra.com, email:
If you wish to fax your form, first call 808-244-4103 and we'll switch over to