2018 Circlework Leadership Training
September 26- October 2 2018
Date of Birth
Address Line 2
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Bosnia and Herzegovina
British Indian Ocean Territory
Central African Republic
Democratic Republic of the Congo
Republic of the Congo
Papua New Guinea
Saint Kitts and Nevis
Saint Vincent and the Grenadines
Sao Tome and Principe
Trinidad and Tobago
United Arab Emirates
United States Minor Outlying Islands
Virgin Islands, British
Virgin Islands, U.S.
Home Phone Number
Cell Phone Number
Are you applying for a scholarship?
Do you have any special dietary restrictions? If so, please explain.
Cost, including tuition, accommodations and gourmet vegetarian meals at Light on the Hill, Ithaca, NY:
$1790 Register before August 1, 2018. A deposit of $900 is required. The $890 balance is due by September 1, 2018.
$1990 Register after August 1, 2018. A deposit of $1000 is required. The $990 balance is due by September 1, 2018.
Cancellations: Please take careful note of our cancellation policy as NO EXCEPTIONS will be made: Deposits will be refunded, minus a non-refundable fee of $200, prior to August 26, 2018. No refunds thereafter.
Please choose from the list of following payment options
I have enclosed a check for my deposit, payable to Meetings in Sacred Space, PO Box 848, Ithaca, NY 14851and will pay for the balance by the due date.
I have enclosed a check for the full amount, payable to Meetings in Sacred Space.
Please charge the deposit only to my credit card (Visa or MasterCard). (The balance will automatically be charged to the same account.)
Please charge the full amount to my credit card (Visa or MasterCard).
Credit Card Information
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Please note that admission to the Circlework Training is by application only. Some applicants may not be accepted into the training program. Please read the terms and conditions set forth below carefully, and acknowledge your acceptance by signing where indicated.
I understand and agree that if I am accepted into the Circlework Training, my continued participation is at the sole discretion of the trainer. If at any point and for any reason whatsoever the trainer should request that I discontinue the training program, I agree that I will do so immediately. I understand and agree that in the event that the trainer requests my discontinuation in the program, the trainer will have no responsibility or duty to reimburse my payments, or for any expenses I may have incurred for travel, lodging, food, or other related purposes.
I understand that the level of my participation in this training and in any of the activities related to it is at all times completely my choice. I may withdraw from the Training at any time. I understand and agree that in the event that I voluntarily choose to discontinue the Circlework Training, the trainer will have no obligation to reimburse or compensate me for the non-refundable portion of my payments or for any expenses, costs, or obligations I may have incurred.
In the event that any workshop with Jalaja Bonheim organized by Meetings in Sacred Space for which I have registered does not take place, Jalaja Bonheim will refund prepaid training fees and deposits. I agree that beyond that, she shall have no obligation to compensate me in any way or for whatever reason.
I understand that the Circlework Training is an educational program, and that it is not a substitute for medical treatment, psychotherapy or any program designed and intended to address matters of physical or mental health. I understand and agree that I am responsible for my behavior at all times while participating in the Circlework Training.
I understand that this program may offer a variety of activities that may be mentally or emotionally challenging. I willingly and knowingly assume for myself all risk of physical injury and mental or emotional upset which may occur during or after the Circlework Training, and I hereby agree to hold Jalaja Bonheim harmless from any and all liability arising out of or in any way related to my participation in the Circlework Training.
I understand and agree that I will not take any photographs or make audio, video, or film recordings of Circlework events without express written permission from Jalaja Bonheim. I further agree not to reproduce, play publicly or sell any part of any photo or recording made during her circles, except with her express written consent. I understand that all rights, including copyright, of such photographs or recordings are and remain the exclusive property of Jalaja Bonheim.
I acknowledge and agree that any training materials used in the Circlework Training are protected by copyright, and I agree that no copies of materials or recordings may be made without prior written approval.
I hereby affirm my understanding and agreement that my participation in the Circlework Training does not certify me as an authorized Circlework leader or trainer. If I lead circles, I agree that I will not use the term Circlework in the headings and titles of printed materials promoting my circles, as this term is a legally protected trademark. I understand that the purpose of this agreement is to protect the integrity of Circlework as a body of teaching.
In any promotional materials related to circles I intend to lead, I agree to acknowledge Jalaja Bonheim and the Circlework Training.
I have entered into these agreements knowingly and voluntarily. I have read and understand, and as affirmed by my signature below, I hereby agree to abide by the terms and conditions set forth in these agreements.
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