SCHOOL OF TANTRA REGISTRATION FORM You must complete a REGISTRATION FORM and one of the following to register for Classes: ADMISSIONS APPLICATION | SCHOLARSHIP APPLICATION | SPONSOR APPLICATION

Person One Information: First Name _______________________________  Last Name  ______________________  I am male ____;  female _____;  couple ______;  single _____; In a relationship but coming as a single ___ *Birth date:  Month ________  Day ________  Year ______ Email  _________________________________  I wish to receive the newsletter?  Yes _____  No _____ Person Two Information: First Name _______________________________  Last Name  ______________________  I am male ____;  female _____;  couple ______;  single _____; In a relationship but coming as a single ___ *Birth date:  Month ________  Day ________  Year ______ Email  _________________________________  I wish to receive the newsletter?  Yes _____  No _____ One person only needs to complete the rest of the application even if there are two people: Telephone:    Home  (____)______________________  Work: (____)_______________________                      Cell:   (____)______________________ Address: Street _________________________________ City: _________________________________  State/Province: _________________________  Zip: ______________   Country: _______________________ ______  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) What is your relationship status?  _______________________ I am (pick the one that best describes you)  ______ Monogamous _____   Polyamorous _____   Lifestyler _____   Playcouple  _____   Curious about the lifestyles What is your sexual orientation?  ________________________ Do you have any experience with tantra?  _____________________ What attracts you to our DreamMatch Clubs?  ___________________________ Do you hope to find a date at this party/event?  If so, indicate which of the below you are seeking: ____ single man;  _____  single woman;  _____ couple;  _____ triad;   _____ foursome;  ______ group Signature:  __________________________________________ ANNUAL DreamMaker MEMBERSHIP FEE: Good for DreamMaker Dating & Relationship Clubs: MINGLES FOR SINGLES, TANTRA CONNECTION, POLYAMORY CONNECTION or CLUB TANTRA.. Membership fee must be renewed each year.  $150 single, $150 couple, $200 triad.  Note:  Membership Fee includes your initial Orientation Interview and upon renewal your second and consecutive years, a free annual review session.   You must complete one of the following: Tantra Orientation Interview, Polyamory Orientation Interview or Mingles Orienation Interview ($150) before you can participate in our DreamMaker dating/relationship groups and parties. Please complete an Orientation Interview Application. Our groups are for singles, couples, triads, groups. All relationship styles and sexual orientations welcome.  DreamMatch Groups & Parties: 10 coupons good for 10 admissions for $200 single, $250 couple, $300 triad.  Annual unlimited admission pass: $500 single, $750 couple, $1000 triad.
MEMBERSHIP
ANNUAL MEMBERSHIP FEE: Good for DreamMaker Clubs: MINGLES FOR SINGLES, TANTRA CONNECTION, POLYAMORY CONNECTION or CLUB TANTRA and includes your Orientation Interview or Annual Review.
Single	Couple/Pair	Triad
___ $150 single	___  $150 couple/pair	___ $200 triad
Date you'd like your Interview or Annual Review: ___________  Time ________  AM ___  PM ___
MINGLES FOR SINGLES GROUP: (Ongoing: Meets 1st & 3rd Friday, Monthly, 7pm) For Monogamous Singles: Heterosexual, Gay and/or Lesbian
__  Mingles Orientation Interview $150
Date you'd like your appointment: ___________  Time ________  AM ___  PM ___
__  Mingles Group $200/10 weeks  ___ $25 per week - singles only (Mingles Orientation Interview) __  Mingles Group $500 single annual pass
__  Mingles Group $500 Annual Unlimited Admission Pass
Date You're attending _________________
TANTRA CONNECTION:Tantra Group for singles, couples, triads, all orientations and relationship styles. (Ongoing beginning/intermediate level tantra group: Meets 2nd & 4th Friday, Monthly, 7PM)   __  TANTRA ORIENTATION INTERVIEW: $150 (Prerequisite for Club Tantra and/or Tantra Connection, 1-2 hours)   Date you'd like your appointment: ___________  Time ________  AM ___  PM ___
___ $25 single admission	___ $50 single admission couple	___ $75 single admission triad
___ $200/10 weeks single	___ $250/10 weeks couple/pair	__ $300/10 weeks triad
___ $500 single annual pass	___ $750 couple annual pass	__ $1000 triad annual pass
Date You're attending _________________
CLUB TANTRA PRIVATE CLASS & PARTY: (advanced level party, gender balanced: (Saturdays, 7PM) For singles, couples, triads, groups, all orientations (straight, gay, lesbian, bi) and relationship styles  (monogamous, swinger, polyamorous, etc.) welcome.
__ $100 single m,   __  $50 single w	___ $100 couple/pair	___ $150 triad
__ $1000 single man annual pass	___ $1000 couple annual pass	__ $1500 triad annual pass
__ $500 single woman annual pass
Date you'd like to attend: ___________
POLYAMORY CONNECTION: Ongoing Dating/Study Group for those interested in polyamory, swinging, pair-dating and lifestyle activites.  Polyamory Connection Meets Wednesdays, 7PM, Monthly.
___ Polyamory Orientation Interview $150, 1-2 hours (prerequisite to Polyamory Connection classes)
Date you'd like your appointment: ___________  Time ________  AM ___  PM ___
___ $25 single admission single	___ $50 single admission couple	___ $75 single admission triad
___ $200/10 weeks single	___ $250/10 weeks couple/pair	___ $300/10 weeks triad
___ $500 single annual pass	___ $750 couple annual pass	_ _  $1000 triad annual pass
Date you'd like to attend: ___________
DreamMaker Mixers - Mixers meet last Saturday, 7PM, Monthly ___ Orientation Interview $150, 1-2 hours (prerequisite to DreamMaker Events) Date you'd like your appointment: ___________  Time ________  AM ___  PM ___   ___ $25 single admission single ___ $50 single admission couple ___ $75 single admission triad ___ $200/10 weeks single  ___ $250/10 weeks couple/pair  ___ $300/10 weeks triad ___ $500 single annual pass ___ $750 couple annual pass _ _  $1000 triad annual pass       Date you'd like to attend: ___________
WEEKEND PLAYSHOPS
CELEBRATE SACRED SEXUALITY: 3rd weekend every month, Saturday 9AM - 5PM, Sunday 11AM - 6PM
___  $250 single	___ $395 couple
CELEBRATE SACRED SEXUALITY: June 23-26, 2005 - Special 3-day seminar, Friday 7-9 PM, Saturday 9AM - 5PM, Sunday 11AM - 6PM
___  $295 single	___ $495 couple
PASSION PLAY IN PARADISE: 1st weekend every month, Saturday 9AM - 5PM, Sunday 11AM - 6PM
___ $250 single	___ $395 couple

EDUCATION & CERTIFICATION CLASSES ___ $595 single :      ___ $995 pair Repeat a level, tuition is ___ $295 single, ___ $495 pair (You must attend in person to get this discounted price) Electronic Class  - IUPS (International University for Professional Studies) $200  ____ IUPS (International University for Professional Studies) courses: $200  ___ Private Tutorials - $150 an hour ___ for ___ hours E-MAIL CORRESPONDENCE CLASSES.  ___ $50 ungraded, ___ $100 graded and applicable towards certification. Name of Class  ___________________________________________________________________ In addition to your e-mail class, telephone tutoring is available for $75 per 30 minutes.  Appointment for phone classes must be scheduled in advance of the session. Telephone Tutoring ____ for ____ hours.  ($150 hour, 30 minute minimum sessions) Once you begin a given class, you have 90 days to complete it in order to receive credit.  Professor Lessin will respond within 30 days to your homework.  If further correction is needed, student will be given another 30 days to make the suggested corrections.

RELATIONSHIP COUNSELOR CERTIFICATION PROGRAM
___ Level I: CERTIFIED RELATIONSHIP PRACTITIONER (C.R.P.)
___ Level II: CERTIFIED RELATIONSHIP TUTOR (C.R.T.)
___ Level III: CERTIFIED RELATIONSHIP COACH (C.R.C.)
TANTRA CERTIFICATION PROGRAM (TANTRA SCHOOL)
Level I: CERTIFIED TANTRA PRACTITIONER (C.T.P.)  2005: 2006:    ___ January 23-28, 2006   ___ February 20-5, 2006   ___ March 20-25, 2006   ___ April 17-22, 2006   ___ May 22-27, 2006   ___ June 19-24, 2006   ___ July 24-29, 2006   ___ August 21-26, 2006   ___ September 18-23, 2006   ___ October 23-28, 2006 ___ November 21-26, 2005 ___ November 20-25, 2006 ___ December 19-24, 2005 ___ December 25-30, 2006
Level II: CERTIFIED TANTRA COACH (C.T.C):
___ March 6-11, 2006
___ September 4-9, 2006
___ March 5-10, 2007
___ September 3-8, 2007
Level III: CERTIFIED TANTRA INSTRUCTOR:
___ April 3-8, 2006
___ October 9-14, 2006
___ April 9-14, 2007
___ October 4-9, 2007
Level IV: CERTIFIED TANTRA TEACHER (C.T.T.):
___ November 7-12, 2005
___ May 8-13, 2006
___ November 6-11, 2006
___ May 7-12, 2007
___ November 5-10, 2007
Level V: PROFESSOR OF TANTRIC STUDIES (P.T.S.)
___ December 4-9, 2006
___ December  3-8, 2007
PASTLIFE CHILDHOOD REGRESSION CERTIFICATION PROGRAM
Level I: CERTIFIED PASTLIFE & CHILDHOOD REGRESSION PRACTITIONER (C.P&C.R.P.)
____ November 14-18, 2005
____ May 15-19, 2006
____ November 13-17, 2006

GROUPS

____ Alien Experience: Breaking the Godspell Study Group $200/10 weeks  ___ $25 per week

____ Dreamwork Workshop $125

____ Existential Life Review Group $125/3 hours

____ Gestalt Therapy Workshop $125 (includes book)

____ Holotropic Breathwork Group Class $125/day (includes book)

____ Jealousy Management Workshop: From Jealousy to Empathy - 1 day ($125)

____ Journey To Tomorrow - $12 (includes book)

____ Men's Group $200/10 weeks  ___ $25 per week

____ Vini Yoga Group $15

____ Voice Dialogue Group $125/3 hours

____ Woman's Circle $200/10 weeks  ___ $25 per week

PRIVATE CLASSES & COUNSELING

____ Alien Experience Integration $150 hour, ___ hours

____ Childhood Regression $150/hour, ___ hours

____ Counseling $150/hour, ___ hours

____ Dreamwork $150/hour, ___ hours

____ Existential Life Review  $150/hour, ___ hours

____ Gestalt Therapy $150 hour, ___ hours

____ Holotropic Breathwork/Spiritual Emergence $150/hour, ___ hours

____ Hypnotherapy, Childhood Regression/Futurelife Progression $150/hour, ___ hours

____ Past-Life Regression, Future-Life Progression $150hour, ___ hours

____ Personal Growth Coaching $150/hour, ___ hours

____ Spiritual Releasement Therapy $150 hour, ___ hours

____ Spiritual Emergence/Emergency $150 hour, ___ hours

____ Voice Dialogue $150 hour, ___ hours

Date you'd like your appointment: ___________  Time ________  AM ___  PM ___

POLYAMORY * LIFESTYLES * SWINGING

____ Alternative Lifestlyes/Polyamory Counseling $150/hour, ___ hours

Date you'd like your appointment: ___________  Time ________  AM ___  PM ___

TANTRA

____ Couples Tantra Massage $150/hour, ___ hours

____ Tantra Coaching/Counseling $150/hour, ___ hours

____ Adore Aphrodite (Tantra: Loving A Woman) $150/hour, ___ hours

____ Delight Dionysius (Tantra: Loving A Man) $150/hour, ___ hours

____ Share Shakti & Shiva (Tantra: Loving Each Other) $150/hour, ___ hours

YOGA

____ Vini Yoga $85 hour, ___ hours

Date you'd like your appointment: ___________  Time ________  AM ___  PM ___

One person only needs to complete the rest of the application even if there are two people:

Telephone:    Home  (____)______________________  Work: (____)_______________________ 

                    Cell:   (____)______________________

Address: Street _________________________________ City: _________________________________ 

State/Province: _________________________  Zip: ______________   Country: _______________________

______  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)

What is your relationship status?  _______________________

I am (pick the one that best describes you) 
______ Monogamous
_____   Polyamorous
_____   Lifestyler
_____   Playcouple 
_____   Curious about the lifestyles

What is your sexual orientation?  ________________________

Do you have any experience with tantra?  _____________________

What attracts you to our DreamMatch Clubs?  ___________________________

Do you hope to find a date at this party/event?  If so, indicate which of the below you are seeking:

____ single man;  _____  single woman;  _____ couple;  _____ triad;   _____ foursome;  ______ group

Signature:  __________________________________________

Registration Options

___ Check  (Note: check must arrive by Wednesday before the event in order for you to be granted admittance).  

___ Money Order

___ Credit Card (CC number, name on credit card, expiration date, billing address, phone, email address (for electronic receipt). Fill out section below.

Accommodations:

____  I need accommodations for these DATES _______________    

Groups begin 7PM and officially end at 10 PM with the exception of Club Tantra which ends at midnight.   you intend to stay past midnight, you must arrange for accommodations.  Please indicate your 1st, 2nd and 3rd choice of accommodations.  You will be sent written confirmation of your reservation.  Accommodations are granted based on availability and location of the event.  Prices listed are approximations and availability may vary based on party location.  Please register in advance to secure your preference.

____ Dorm Space ($35/night single, $40 couple) Futons are available on a limited basis. Register early to guarantee a futon.  

____ Private Room/Shared Bath ($65 night)

 ___ Private Room/Private Bath ($75 night)    

I plan to arrive on DATE __________   TIME _____

PAYMENT BY: _____ CHECK / _____ VISA* / ____MC* / ____ MONEY ORDER _____ 

If your check, credit card, or money order is covering anyone other than yourself, please say who you are paying for and give their e-mail address and phone number.

 _________________________________________________________________________________________

CREDIT CARD INFORMATION
Credit Card payments will appear on your statements as paid to “World Tantra Association”

Name on Credit Card (including any middle initial): 

First  __________________________     Middle Initial _____  

Last ____________________________________
                                            

Complete Billing address on Credit Card: 

Street  ________________________________________________  City ______________________________

State/Providence _________________________________  Zip _______________________    

Country _________________                                                                                                                                                    

Credit Card Number: ___________________________________ Expiration date :_____/______/

Signature:  _________________________________________

(I hereby authorize this transaction and agree to the terms on this form).

 

Application Processing Fee and Orientation Interview Cost: $150 *

* All students must complete an Application plus Orientation Interview before admission to our programs and events.  Interview can be in person or via phone. If your total for groups and classes is more than $500, Orientation Interview is Free.  Orientation Interview Cost: $150. (Single women are Free until September 30, 2005)

Please complete a REGISTRATION FORM to register for events or classes.  Send completed forms to the address at the end of this form.   call and schedule your private orientation interview or let us know which Friday you'll be attending the group orientation interview. 

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)
 

TOTAL AMOUNT PAID: $ ________  DreamMaker membership fees and party admission must be paid in full when making reservations.  All other events, groups, private instructions and accommodations require a 50% deposit to hold your time and space and the balance is due one week before the event or appointment.  This document must be signed and delivered to us in order to process credit card transactions and secure your time and space at our events.  

* NOTE: These groups are for Member's only.  Location of the events may vary.  Members agree to keep the location of the events private.  You must provide an accurate email or phone number in order to get directions.  If you've not received directions by the day of the party, call 808-244-4103 by 4pm the day of the event to get directions.  

Please be on time.  Give yourself plenty of time to find the place.  Refund policy is strictly adhered to, so be sure you want to attend before registering.  These events are structured and begin on time.  No late admittance..   

No refunds on the day of the event or 5 days prior to the event.  

CANCELLATION FEES
If you cancel 90 days or more - your penalty is 25% of price 
if you cancel 60 days or more - your penalty is 40% of price 
if you cancel 31-59 days - your penalty is 50% of price 
if you cancel 6-30 days - your penality is 75% of price