The Foundation for Union with Truth Enlightenment Intensive Retreat Questionnaire: Please fill
this out completely and mail it back with your deposit of $100 to 5415 S. K Street Tacoma, WA 98408
If you have any questions please call Wayne at (253) 310-2667

Print Clearly (use back side of page if necessary)

Name____________________________________________________Date_________________

Name you like to be called: __________________________ Occupation __________________

Street Address _________________________________________________________________

City _____________________ State ________________ Country______ Post Code _______ 

Phone Home ________________ work _____________________

mobile ______________________ 

Email __________________________________

Married____ Divorced___ How many Children_______

Are you here by your own free choice? __________

How did you find out about the Enlightenment Intensive Retreat _______________

Is English your native language? _______ If not, what is? _____________________

What other growth techniques have you participated in? __________________________________________
_________________________________________________________________________________________

Do you have any current problems that may keep you from being able to be here with your full attention? 
If yes, explain: _______________________________________________________________________
____________________________________________________________________________________

Are you here to work solely on enlightenment? __________ 
What is the state of your health? ______________________

Do you have any history of chronic illness? _________________ 
If yes, explain? ________________________________________
____________________________________________________________________________________

Are you currently taking any medication or legal drugs? 
If yes, explain: _______________________________________________________________________

Do you have any food or vitamin allergies? ____ If yes, explain: ______________________________

Do you have any significant dietary considerations? ____ If yes, explain: ____________________________________

Do you drink coffee? _____ If yes, how much? _________ Do you smoke cigarettes?_____ If yes, how much? _______

Have you taken illegal drugs?_____ Do you currently take any?_______ If yes to either explain: _____________________________________________________________________________

Do you easily become depressed or very elated? __________

Have you or members of your family ever been in a mental institution?______ If yes, explain: _____________________________________________________________________________

Write here anything else you think I should know about you:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

 I hereby acknowledge that I am here by my free choice and I take full responsibility for my health
and well being.

Signed __________________________ Date __________________

General and Medical Release

I understand that an Enlightenment Intensive Retreat or Love Intensive is a powerful and at times physically
and emotionally stressful activity. I have chosen to participate in this workshop of my own free will and
without coercion. I recognize that these workshops are spiritual retreats and not a form of mental or medical therapy. 

I also understand that I will not be asked to do anything illegal or immoral, and that I have the choice to
participate or not in all meditations, dyads and other activities.

I take full responsibility for all my actions and therefore release the workshop leader, staff and assistants
from all legal and medical liability with respect to this workshop and its effects.

The staff members of this workshop are committed to the task of seeing that you are safe, nourished,
cared for, and encouraged in your pursuit of Truth.

Signature of Participant ________________________ Date _______________

Workshop Facilitator __________________________ Date _______________

Upcoming Enlightenment Intensives

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