Name*

Address*

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Country

Phone

Email*

Date of Birth*

day

/

month

/

year

Occupation

Have you listened to the Part 1 of the Lightning Process audio programme or read the Introduction book?*

Are you willing to attend and participate in the discussions, training and coaching sessions?*

Do you agree to maintain confidentiality with regard to personal information shared by others during the training?*

Pippa runs courses in Bristol, Worcester, Oxford and Canada. Please fill in the box if you have a venue preference. Please also contact us if you are interested in doing a course in South Africa or Ireland.

Personal History

How would you describe your illness/symptoms/issues? (include medical name/diagnosis if relevant)*

When did your symptoms/issues begin?*

Date of diagnosis

How did they start?

How has this affected your life?

Do you need wheelchair access to get to the venue?*

Do you feel you can influence your own health?*

Do you believe you can get better/resolve your issues?*

To help us assess your suitability for the seminar please tell us if you have any medical or mental health issues that you have not yet mentioned on this form. If so, please list them:

What do you hope to achieve from doing the course?*

What would you love to do with your life?

Have you applied to take the training before?*

Would you like to be accompanied at the seminar?

As space can be limited on some courses, please discuss availability with your practitioner during your phone call, if you would like to be accompanied. This person will need to complete a separate Learning Facilitator form.

Do you agree to maintain confidentiality with regard to personal information shared by others during the training?*

Payment Details:
The training fees for taking the Lightning Process with Pippa Adamson are £750 This
includes 3 hours of free follow-up coaching. Payment is required by Bank Transfer
and is only payable once you have been accepted onto a course.

Training Agreement:
You should only sign this application form if you agree to the terms and conditions on the following page and to the following statement:“I understand that the Lightning Process is a training programme. Its purpose is to train me in the tools of the Process, and I realise that simply attending will not guarantee me results. I recognise the changes I want can best be obtained by fully participating and engaging in the seminars and continuing to apply the tools afterwards. I am ready and committed to do this.”

Signature (to sign, please type your name)*

Date*

Emergency Contact
So that we can contact someone close to you in the case of an emergency please provide:

Emergency Contact Name*

Emergency Contact Phone Number*

The following must be completed if you are under 18 years of age:
If you are under 18 years of age please ask your parent/guardian to read through the form and if they also agree to the terms and conditions, for them to sign the form too.

Parent/Guardian Name

Parent/Guardian signature (to sign, please type your name)

Date Signed

Relationship to Applicant

Terms and Conditions

Online Seminars
By completing this form, you are agreeing that you are happy to use a third-party
software package (Zoom) to participate.

Confidentiality
The Lightning Process is a training programme and while there is no requirement for
you to share personal information with other members of the group, some people may
choose to do so; because of this, we require your agreement to maintain
confidentiality with regard to personal information shared by others during the
training.

Conditions of Payment
Once paid, you have seven days to cancel your booking and receive a full refund if training has not commenced. After this, fees cannot be refunded in the event of a cancellation on your part, or a failure to complete the training. This is because I 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. I reserve the right to terminate your training if I 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 me to cancel a
seminar and accordingly we reserve the right to cancel seminars where appropriate.
In such circumstances, you will be given as much notice as possible and I 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
In completing this form, you are agreeing to protect the copyright and Intellectual
Property of the materials provided by the Lightning Process Practitioner. All documents you receive as part of your training constitute intellectual property and are not to be reproduced, lent, sold or by any other method disseminated to any other person or entity without the express written permission of Lightning Process Ltd. Such restriction applies equally to the entire contents of the materials or any part of them. You are also agreeing not to record or take photos during the seminar or any follow up. Such restriction applies equally to the entire contents or any part of them.

Copyright Notice
The purpose of the Process is to apply it to resolve your personal issue(s).
Participation in the Process does not amount in any way to permission to reproduce
or train others in any of the techniques or materials (including graphical images, text,
audio or visual presentation) that are demonstrated or provided.

Data Protection Policy
Both Newleaf and the Head Office for the Register of Lightning Process Practitioners is registered with the Information Commissioners Office (ICO) and all information is held in accordance with the General Data Protection Regulations 2016/679 (GDPR) and Data Protection Act 1998. Please refer to the Newleaf Privacy Policy here and the Lightning Process Head Office Privacy Policy here.

You can decide to have your attendance certificate logged, together with your name,
certificate number and email address with the Lightning Process Head Office. This
will:

Ensure that it can be replaced in case of loss
Help us with our research and statistics
Help us to check that you have received the high standard of care we expectfrom members of our register

If you would like this option, please check 'YES' with the dropdown option below.

If you would like your attendance certificate logged please select Yes or No:

In addition to the logging of your details for the purposes outlined above, we would also like to occasionally inform you of relevant developments in the Lightning Process® and its associated programmes. This is an optional service. Your details will never be passed on to anyone else for any reason.

Please select Yes or No if you wish to receive occasional and relevant correspondence from us about this, including Phil Parker's monthly newsletter.

In order to conduct further research into the Lightning Process we would like to contact you at regular intervals to monitor your progress. We will not use any details by which you may be identified in any statistics that we produce Please check the box if you agree to this.

Do you want to receive OCCASIONAL emails from Newleaf about our service?

Yes

No

Do you want to receive TOP TIPS monthly from the Get Change Team?

Yes

No

Thank you for filling in this form. Pippa will contact you shortly to discuss your application.