Wailana Malie Massage Clinic MAE 2105

52-4670 Government Rd.,Kapa'au,HI 96755 (808)854-9283

Email:lomihawaii@lomihawaii.com

Date of Retreat attending__________________
Name_____________________________________________________
first middle last (as it to appear on certificate.)
Date of birth_________________
mailing address___________________________________________
___________________________________________Email:_____________________
telephone numbers- home___________________ soc.sec. #_____________
in case of emergency, notify____________________________________
please list any medical problems, major operations, injuries, etc: _______________________________________________
are you under the care of a physician, psychiatrist, or any other type of treatment? Yes/no
if so please indicate: _____________________________________
please list any medications: ______________________________
have you had any previous experience with bodywork? Yes/no
what types?______________________________________________

Are you a licensed therapist? Give us your License or Massage permit number________________________________________
please tell us why you want to study Hawaiian lomi lomi massage______________________________________________________

_____________________________________________________________

Full payment is due with application. No refund provided, in the event of an emergency you may apply you fee to the next class Spring 2009.
Fee for Begining Lomi Lomi Retreat is $600.00.

Advance Lomi Lomi Retreat is $400.00.

5 Day Class Begining and Advance combined $1000.00.

$600.00 Begining Class

$400.00 Advance Class

$1000.00 Class Fee deposit included

Fee includes dormitory lodging, meals(breakfast, lunch, dinner), and class instruction & massage supplies. There are separate dormitories for men and women, each dormitory has their own communual toilets & showers. Students must bring their own linens, sleeping bags, pillows, towels, laundry facilities are located on property for $.50 washer and $.50 drier.

For those who need B & B accomodations you will pay the class fee and you must rent your own room at the local B & B and get your own rent a car. We do not provide transportations to Makapala. http://www.kcadventures.com/ is 5 minutes from Makapala in the town of Kapa'au.

Fee does not include personal items ex. shampoo, tissue paper, soap, sanitary napkins, toothpaste, mouthwash, bottled water, soda/soft drinks. 

You must go to CostCo. & Wal-Mart before going to Makapala to purchase these supplies.

No transportation provided from Kona Keahole Airport for this workshop, you must rent a car or take a taxi.

Release of liability
the undersign hereby releases any and all liability and/or damage incurred during the course of the  Hawaiian Lomi Lomi Massage Art & Culture Retreat.
Furthermore, the undersigned releases Wesley Sen and Lehua McCandless-Sen, Makapala Retreat Center, their apprentices and/or agents from any and all damage and liability incurred due to negligence or the undersigned and/or of others.
The undersigned hereby agrees and understands the above:
date: ______________________

signature: _______________________________________________________

printed name: _____________________________________________________