Le Centre Du Silence

International Summer Mime Workshop
of the BodySpeak™ Method

Application & Confidential Questionnaire

PRINT AND MAIL THIS FORM

Directions to complete your application to Le Centre Du Silence.
1. Fill in form or print out this form and mail it.
2. Fill in your name, address, and phone on this form.
3. Print or type clearly your answers to the questions below or on separate paper.
4. Review and approve the Participant Agreement (make a photocopy for yourself).
5. If mailing, return 1, 2, and 3, to LCDS with a photo of yourself. If electronic registering, mail a photo of yourself to LCDS.
6. When accepted, you will receive the welcoming letter of confirmation.

First Name
Last Name
Occupation
Birth Date
Age
Phone
Address
City
State/Province
Zip/Postal Code
E-mail Address
Date

Questionnaire:
1. State your educational background, including all diplomas, certificates and degrees, if any.
2. State your theatre, dance, music, mine or any artistic training, giving dates, names of instructors.
3. State your present occupation and your previous work experience.
4. Have you ever been involved in any group or individual psychotherapy?
If so give details.
5. Have you ever participated in any personal growth or religious groups?
Please describe your experience.
6. Why Mime? Why now? What attracts you to this work? State clearly your motivations to study the BodySpeak™ Method.
7. State your expectations of the BodySpeak™ training, indicate the degree of your readiness and dedication to yourself and learning.
8. Describe your understanding of the productive-creative attitude toward learning.
(Teacher-student relationship)
9. State who you are at this point of your growth. What experiences, learning, that drives you to know and why?
10. State one experience, person, place, event, or book that impressed you, and describe a major turning point in your life.
11. Where did you hear about the BodySpeak™ training and Le Centre du Silence?


ANSWERS: (please number your answers, use a seperate sheet if necessary)

Workshop Application
Workshop Agreement
Workshop Page

 

FOR OFFICE USE ONLY.


Date Received
Replied Date
Amount Paid
Check #
Credit Card
Approved by
Welcome Letter Sent Date
Workshop Date