ࡱ>  cBbjbj 4ooi3 7 7 78A7,m7|;77777888;;;;;;;w>A8;88888;977;9998:77;98;999+ 799:;0;9QB9QB999888$" 7 7 :    Please ensure you fill this form in only if you are taking your training with PHIL PARKER at the LONDON CLINIC. If not please visit your practitioners website to fill in their personalised version of this standardised form. Please note: It takes us about 2-4 weeks to process forms due to high numbers and the fact that each one has to be assessed and each person talked to by a trainer. If youd like to know if your form has arrived safely please write your name on the back of the envelope and e-mail us, as that s the quickest way for us to reply. Please fill this extra box in to help speed our up administration. Name: My best contact number is:  Application form for the Lightning Process"! seminar Notes to help you fill in the form. Am I ready to take the training? Please read Phil Parkers book An Introduction to the Lightning Process which is available from the website before completing this form; it will help you to decide if you are ready. Have you read the book An Introduction to the Lightning Process? If your answer is NO, please read the book before completing this form. If you have read the book please fill in the form and send it on to us. After we have received you will be placed in our waiting list. When you reach the top of that list we will ring to talk to you before you take this training seminar in order to assess if this program is right for you right now. The Lightning Process"! is a training program. Our experience is that if people apply the lessons of the Lightning Process"! to their lives they can start to change old patterns of thinking which in turn influence their health and happiness. With any training program the trainer can only take responsibility for training and coaching to the best of their ability, then the student must apply the lessons for himself or herself. If the student doesnt apply the training, then they will naturally see very little benefit. We recommend that you think long and hard before taking this training, does it sound like something that appeals to you, and makes sense to you, something you can commit yourself to? If you feel doubtful, cynical or just want to give it a go to see what happens, then now is probably not the right time for you, so please be honest with yourself and this form or you will probably be wasting your time and money. How the training is conducted Much will be demanded from you over the three days of the seminar, but if you take on the challenge, which your trainer will assess you for in terms of your readiness, the rewards are extraordinary. Your trainer has a very demanding role during the seminars. They have to not only present the material but also manage and assist you as you go through that very challenging process. There are certain ground rules and understandings that will make the training easier for you and them. Your trainer is completely committed to your success, as a result; They wont tolerate any behaviours that prevent you getting the success that you deserve. They will deliver no-nonsense, honest and essential feedback, do not mistake this as not caring. They will not always say what you want to hear. If what you are doing is going to cost you your success they will tell you even if it risks you being annoyed with them. Thats how committed they are to you and your success. Your role in the training You will need to fill in the training agreement that is included in the application form below. PLEASE MAKE SURE YOU FILL IN ALL SECTIONS 1.Agreement Please read these statements, and if you agree with them please circle the AGREE word, we will not accept you onto the training program unless all the statements are agreed to. Our experience suggests you should only take the training if you agree to these statements: I understand that the Lightning Process"! is a training program Agree I understand that learning the Lightning Process"! does not guarantee me any results. Agree I accept full responsibility for the effects of applying or not applying this training program to my life. Agree I recognise that the mind and body can powerfully influence each other. Agree I am prepared to look at and challenge my beliefs about my condition/illness, my health and myself. Agree I am totally prepared to do the sometimes-challenging work, of starting to think very differently, that is required to get myself back on track. Agree 2. Personal details and history Name Name you wish to be called if different Address: House number: Street Town County Country Post code Tel home Tel work Email About you (this helps us to ensure the course is suitable for your needs, gives a sense of who you are): Sex male/female Date of birth Occupation What you hope to get from doing the course How would describe your problems/issues/illness: (include medical name/ diagnosis if relevant) When did your issues begin? How did they start? What effects has this had/how has this limited your life? I know someone whos used the Lightning Process to recover their health: yes/no Their name if known 3. Future When you have discovered a way to get well/ resolve your issues what will you put your energies into/what would you love to do with your life? 1 2 3 4 5 6 7 8 4. Readiness Overall, what score would you give yourself out of 10 for your belief that you can recover using the Lightning Process, where 10 means I definitely can and 0 means I cant? Please score each of the following out of 10, where 10 means I totally agree with this statement. Statement one: I want to resolve all my issues. Statement two: It is possible for me to resolve all my issues. Statement three: I am capable of learning how to resolve all my issues. Statement four: It is appropriate for me to resolve my issues and I am prepared to do what it takes to make those changes Statement five: I am willing to change negative lifestyle patterns, thought processes and limiting beliefs Statement six: I have the responsibility for resolving these issues and the power to do that Statement seven: I deserve to and am valuable enough to resolve my issues Statement eight: In terms of my issues and my ability to follow instructions, I am similar enough to all those others who have used the process to recover that I am bound to make the same kind of changes as them I am determined to be the next success story yes 5. The X factor Please write down a few sentences on what you feel is needed from YOU during the lightning process to get the changes that the others have achieved. 6. Please select one answer a) If you are presented with information do you tend to accept things as they are rather than tending to question them? Yes No Other b) If others can get well using the process then so can I- do you agree? Yes No Other c) My type of illness/issues (that I want to use the process on) are generally easily recoverable from. It is definitely this way d) My specific illness/issues are easy to resolve using the process. It is definitely this way e) My issues are different from other peoples ones. It is definitely this way f) Pair the words on the left with just one that has an opposite meaning. Simple SmoothSmoothDifficultShort SmoothComplexSoftRough SmoothHighTall Can you suggest any improvements, or comments about the form? 7. Previous and multiple applications Have you applied to take the training before? Yes/no (if no, go to question 8) If yes which trainer did you apply to: and when: What has changed for you since applying to that trainer? To process your application we will need to speak to that trainer about your case, please only send in the application form if you agree to this. Please do not send in multiple applications to different practitioners. 8. Training Agreement Please read and if you agree to it, sign it. I promise that during the training I will: Deeply and honestly examine my beliefs. Be available for coaching at all times. Change anything that my trainer identifies as destructive. Be open to feedback of the trainer and my fellow trainees. Recognise that I have blindspots that I dont even know I have. Signature Date 9 Payment details Fees for Lightning Process seminar with Phil Parker, the designer of the process, are 1,500. Please make cheques payable to PPW LTD. Payment is by cheques or bank transfer (please contact us for our bank details or if you live outside the UK our iban and swift codes once you are accepted onto the seminar) only. Please ensure you fill this form in only if you are visiting the LONDON CLINIC in Crouch End N8. If not please visit your practitioners website to fill in their personalised version of this standardised form Terms and conditions: Conditions of payment Once paid fees can not be refunded in the event of a cancellation on your part, or a failure to complete the training; this is because we run small group trainings with limited spaces; if you take up a space and cancel, no one else will be able to fill it once the course starts. However, if you cancel at short notice and we are able to fill your space your fees will be refunded We reserve the right to terminate your training if we feel your continued participation would be unhealthy or unhelpful for you or another member of the training group. Your fees will not be refunded in these circumstances. Cancellation of seminars On occasion unforeseen circumstances may make it necessary for us to cancel a seminar and accordingly CEC LTD reserves the right to cancel seminars where appropriate. In such circumstances you will be given as much notice as possible and CEC LTD will either refund the full seminar fee or, if you request, move the training to an alternative date. Liability for any losses other than the seminar costs will not be accepted. Ownership. All documents you receive as part of your training constitute an intellectual property and are not to be reproduced, sold or distributed in anyway. If you agree to all of the above conditions in this document please fill in and sign the following declaration. I understand and agree that once I pay my fees they cannot be refunded; that I understand the statements I have agreed to and agree to adhere to the above conditions. Signature This must be completed if you are less than 18 years. If you are under 18 years age please ask your parent or guardian to read through the form and if they also agree to the terms and conditions, for them to sign the form too Name Signature (as this is an on line form please print your name if you would like it to represent your signature in this document) Relationship to applicant Date IMPORTANT If you are planning to bring someone to help you in your learning please get them to fill in the form that you can download by clicking  HYPERLINK "http://www.lightningprocess.com/Portals/1/applicationforms/lf.html" here please note spaces are limited so we can not always accommodate your wish to bring someone with you. Certificate of attendance. From August 2008 onwards, on completion of the course you will receive an attendance certificate from your trainer. We foresee that, over time, taking a Phil Parker Lightning Process"! training seminar will be considered a valuable component of an individual s life and work skills. The certificate will act as a reference that you attended the seminar for personal development, which can then be presented to future employers as evidence of your Phil Parker Lightning Process"! training attendance. To ensure this valuable certificate is accurate your trainer will log your name, certificate number and e-mail address with Lightning Process head office (please see our Data protection policy for more details). Data protection policy: The Register of Lightning Process TM Practitioners is registered with The Information Commissioners Office and all information is held in accordance with the Data Protection Act 1988. We will only use your details for our accounting and statistical purposes or to ask you to complete questionnaires to ensure that you have received the high standard of care we expect from members of our register. Agreement to the processing of data is therefore a necessary condition of acceptance onto the training course and by applying for the training course you signify your agreement to this processing and use of your personal data. Separately to that usage of your data, occasionally we would like to inform you of relevant developments in the Lightning Process and its associated programs. This is an optional service. Your details will never be passed on to anyone else for any reason. Please check this box if you wish to receive occasional and relevant correspondence from us about this. q Thanks for helping us speed up your application by filling this out. Please send this form to: Phil Parker, The Lightning Process Seminars, 170 Weston Park, London. 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