Tantra & School of tantra
Please complete the following application before admission to any School of Tantra, Temple of Tantra & Tantra Theosophical Society programs, events, classes, educational programs, dating groups, workshops, seminars, support groups or private sessions. Use a separate paper to answer longer questions and write N/A after questions that are not applicable to you. Each member of a couple must complete a separate form. Youíre not required to answer all the questions; however, the more you tell us about yourself, the better weíll be able to help you. Please answer a minimum of 20 questions. We have groups, sessions and classes for all relationship structures, styles and sexual orientations. We want to place you in the appropriate groups/classes and/or private sessions so you have the best possible experience, learn all you wish, accomplish life goals, experience transcendence and bliss.
Name (first, last, middle) ___________________ Title __________, Temple Name _________________
I am: (check/answer all that apply)
___ Iím in a relationship and have permission from my partner to attend
Birth date: Month ____ Day ___ Year ____
Email _________________________________ Telephone: Home
Occupation ____________________________ Are you employed by a law
enforcement agency? Y/N ___
I live on Maui ______ full time, _____ months a year Iím moving to Maui
1. Describe your existence - your qualities, traits, characteristics and challenges.
2. What would you like? (If more than one apply, number in order of
3. Do you have any experience with tantra? If so, please describe
7. Whatís your current relationship status?
What would you like to accomplish in your session?_________________________________________________________________________________
Do you have any concerns or issues we should know about before your session?
___ I agree my purpose in Temple is to seek knowledge of my soulís energy expression. I understand that the sensitivity and personal nature of the work requires a full commitment on my part as well as my healer, to trust one another as fellow Seekers of body wisdom. I agree that I need not leave my primary faith to explore tantra, the all-is-one nature of existence.
___ I pledge that I shall not receive or give any type of therapeutic
massage during my sessions at the Temple. Tantric Touch and Whole Body
Healing are offered for physical relaxation.
___ I pledge that I shall not receive or give any type of sexual gratification in exchange for money during my session. I offer financial support in gratitude for what unfolds in sessions as a consensual exchange between self-sovereign to expand knowledge of life energy, soul and body.
___ My Healer / Guide and I shall hold in privacy and sacred trust the
information shared during our session and shall not discuss any details
of our experience outside the Templeís transformation chambers.
Please Check All That Apply: At this point I consider myself a:
I am interested in the following (check all that apply)
___ Active Listening
___ All Chakra Yoga
___ Alternative Lifestyles Counseling
___ Ancient Anthropology
___ Bereavement Therapy
___ Childhood Regression
___ Couples Counseling
___ Cultural Conditioning Reprogramming
___ Delight Dionysius
___ Divine Pairs Couples Tantra
___ Ejaculatory Control
___ Erectile Dysfunction
___ Existential Analysis
___ Extraterrestrial Contact
___ Family of Origin Reprogramming
___ Female Ejaculation
___ Full Body Bliss
___ Gestalt Therapy
___ How to Really Love a Man
___ How to Really Love A Woman
___ Holotropic Breathwork
___ Imago Therapy
___ Increasing Orgasmic Potential
___ Life Review
___ Life Between Lives Hypnotherapy
Non Violent Compassionate Communication
___ Pastlife Regression Therapy
___ Personal Growth Coaching
___ Polyamory Counseling and Coaching
___ Premature Ejaculation
___ Primal Therapy
___ Private Yoga Instruction
___ Prostate Health
___ Refining Relationships
___ Religious Deprogramming
___ Shamanic Journeys
___ Share Shiva & Shakti
___ Spirit Releasement Therapy
___ Spiritual Emergence
___ Spiritual Emergency
___ Tantra Certification
___ Tantra Ordination
___ Tantra for One
___ Tantra/Sacred Sexuality Coaching
___ Tantra/Sacred Sexuality Counseling
___ Tantra/Sacred Sexuality Education
___ Whole Body Healing
___ Vini Yoga
___ Voice Dialogue Centering
___ Other (please describe)
Would like to receive our newsletter? If yes, list email here: ________________________________
(Note: your information is confidential and will not be shared with any other group or individual)
would like to attend sessions/classes: ___ Daily, ___ Weekly, ___ Twice
a month, ___ Monthly
What is your budget for private sessions, workshops, events? _________________
Iím interested in the following:
SCHOLARSHIP PROGRAM: I would like to sponsor:
you a current School of Tantra/ Temple of Tantra Member? Y/N ____
Annual Life Review and Introspection
I want to attend: ___ by myself, ___ with __________________________ (name of person)
I would like my next session/class after my orientation or annual review
interview orchestrated as follows: Practitioner (s), Teachers:
Type of Session:_______________
___ I am interested in correspondence/distance learning classes/courses
Payment Method: ___ Master Card, ___ VISA, ___ Discover, ___ American
Express, ____ Cash, ___ Check *(note: checks must be received 7-10 days
before class/group/program/event in order to clear the bank).
___ I wish to make a donation to the Temple for $________
___ I need a receipt so I can receive 501(c)(3) non-profit Temple of
Tantra Church deduction on my tax return
Mail this form along with a copy of your ID showing proof of age and payment to the address below so that we may review it before your appointment. Call 808-244-4103 to schedule your appointment or email us at firstname.lastname@example.org with your request and weíll get back to you ASAP.
I understand that the Temple of Tantra (TOT) /Maui Goddess Temple (MGT) /School of Tantra (SOT) is located in a rustic, hilly and wild area. I and my assignees, heirs, personal and legal representatives, release from liability, hold harmless and will not make any claims (present and future) against TOT, MGT and SOT any of its staff, agents, contractors, guests or volunteers for any physical or emotional injury, including death, that may occur to me and accompanying children, animals or adults at TOT, MGT and SOT including but not limited to slipping and falling, use of any pools or water including infections or drowning and use of any trails; including but not limited to any loss of any kind to my property or vehicle, whether resulting from my own acts, the acts of others, acts of God or from acts of any TOT, MGT and SOT staff, agents, contractors or volunteers. TOT, MGT and SOT is a private, members-only organization and reserves the right to terminate the tenancy of a guest for reasons TOT, MGT and SOT shall deem objectionable.
___ I verify that I am not employed by any law enforcement agencies, massage schools or agencies, nor do I work in law enforcement, massage related or governmental agencies.