Apply for MER Events We understand the potential sensitivity facing some of the questions below. This can be a very vulnerable area in your life. This information is valuable to us for knowing and understanding you better which enables us to make an educated determination about your attendance in the program. We strive to offer the most appropriate and best possible care & support for you. Please answer honestly. These questions and answers are strictly confidential and will be reviewed by our team only. Thank you so much! Are you attending as part of the MER Certification Training or for your own personal experience? Certification Training Personal Experience Are you an new student? New Student Existing Student Training SelectionSelect a training ...14.12. - 20.12.22 ~ Module 5: France, Simiane La Rotonde10.03. - 16.03.23 ~ Module 6: France, Simiane La Rotonde12.04. - 18.04.23 ~ Module 2: Poland28.05. - 02.06.23 ~ Module 7: Greece, Korfu01.07. - 07.07.23 ~ Module 3: Poland14.08. - 20.08.23 ~ Module 1: France, Simiane La Rotonde24.09. - 29.09.23 ~ Module 2: Greece, Korfu27.11. - 03.12.23 ~ Module 3: France, Simiane La Rotonde08.12. - 14.12.23 ~ Module 4: Poland11.03. - 17.03.24 ~ Module 4: France, Simiane La Rotonde02.06. - 07.06.24 ~ Module 5: Greece, Korfu10.08. - 16.08.24 ~ Module 6: France, Simiane La Rotonde22.09. - 27.09.24 ~ Module 7: Greece, Korfu02.12. - 08.12.24 ~ Module 1: France, Simiane La Rotonde Personal DetailsName* First Last Gender* Male Female I don't identify with either Email* Enter Email Confirm Email Phone*Country*Select a countryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabweDate of birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Place of birth* ExperienceHave you ever taken any massage or body work trainings?*Why MER?*Please share why you are interested in joining the MER event.What do you hope to take away from attending this event?* Medical QuestionsDo you have any chronic pain in your body?* No Yes Please tell us about your chronic pain!*Have you ever been under the care of a Psychologist or Psychiatrist in the past?* No Yes Please provide the details of the nature for this care. For what specific purpose? For how long? The results? Any other relevant information.*Are you currently under the care of a medical doctor?* No Yes Please provide the details of the nature for this care.*Are you currently taking any medications?* No Yes If yes, please list the names and what for. For example blood pressure, anti-seizure, asthmatic or COP inhaler* Final Questions and CommentHow did you find us?*Please selectThrough a friendProfessional referralWeb SearchFacebookYoutubeInstagramWebsite linkOtherMay we ask further?You don't need to answer this but it would be great for us to know about your web search. What did you search for and did you use Google or another search engine?Add a message if you wish.HiddenTerms and Confidentiality AgreementPlease read our Terms and Confidentiality Agreement I agree Please double-check your input and submit the form. {all_fields}CommentsThis field is for validation purposes and should be left unchanged.
