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SoundWerk™ Certification Course Registration

206C Wesley Drive, Waynesboro, PA 17268 Phone/text/facetime: 717-387-3280 Skype: lynda.kuckenbrod E-mail: [email protected] Web: www.SoundWerker.com

YOU MUST ADD THIS EMAIL TO YOUR CONTACT LIST TO INSURE THAT YOU RECEIVE A REPLY: [email protected] A REPLY IS SENT TO ALL EMAILS WITHIN 24 HOURS

Full Name:

Street and City:

State/Province and Mail Code:

Telephone~ Home: Cell (is this an iPhone?):

Date of Birth

Skype: Email: Facebook:

Please provide the date of the course for which you would like to participate:

______Date

What type of computer will you be using to take this course? ______

Does your computer have a camera? ______

Have you ever done a video chat on your computer (such as Skype or Facetime)? ______

How did you hear about the SoundWerk Certification Course?

Please complete the questions below:

1 What instrument do you play? How long have you played it? Are you taking lessons now? How would you describe your instrument/music skills?

What are your reasons for taking this course? How will you use this course upon Certification?

SoundWerkers by nature must be compassionate, intuitive, non-judgmental and have empathy. These traits cannot be taught. Do you feel that you have these qualities to be a SoundWerker? If so, please elaborate.

What are your expectations? How can we help you accomplish your goals?

You will receive an answer to you application within 24 hours. At that time we will arrange a meeting to answer any of your questions and to demonstrate your ability with your instrument.

AGAIN – Please add [email protected] to your contact list. I respond to emails within 24 hours. If you do not receive a response, please check your spam folder and send a follow-up email. Your inquiry is important to me.

I look forward to meeting you!