Application Form for The Phil Parker Lightning

Application Form for The Phil Parker Lightning Process®
Training with Alastair Gibson @ “withinspiration”
Tel 01202 269972
It’s great that you are intending to do the Lightning Process and ready
to create wonderful changes in your life! I look forward to being able to
help you on that journey.
Name:
Address:
Postcode:
Country:
Tel Home:
Mobile:
Email Address:
Male/Female:
Date of Birth:
Occupation/Previous Occupation:
How did you hear about Withinspiration and the Lightning Process
If you heard about us from someone that has completed the Lightning Process then
please enter their name as they may qualify for future discounts
Thank you for choosing to apply to take the Phil Parker Lightning Process with
Alastair Gibson. Please take your time to go through this form as it will help me to
find out more about you and what you are hoping to achieve from taking this training.
If you have any questions, please contact me at: 01202 269 972 where I will be happy
to talk them through with you.
Please select preferred venue
Bournemouth, England
Poole, England
London, England
Bristol, England
Bath, England
Southampton, England
Stubbington, England
Antrim/Belfast, Northern Ireland
Edinburgh, Scotland
Glasgow, Scotland
Preparing for your training
The Lightning Process® is a training programme, not a treatment or a therapy so you
need to be ready to learn. Our experience is that if people apply the skills/tools that
they learn from doing this course, then they are able to make changes to achieve new
levels of health, wellbeing and happiness.
The Lightning Process is all about you and your future. As it is your future, you will
have the biggest role to play during the seminar, will have to do the most work and be
very determined. This is why we recommend that you have more of a commitment to
the training and success than just ‘wanting to give it a go’. Having said that, you will
not be alone on your journey, I your practitioner will be there for you before, during and
after the course to help you to keep putting the Lightning Process into practise.
We have found that the very best way to help you to prepare yourself to get the most
from the training is to read/listen to the book/audio book ‘An Introduction to the
Lightning Process’ which is available from Alastair at Withinspiration.
Also take some time to read through the website www.withinspiration.co.uk especially
the feedback and stories from people who have already done the Lightning Process. If
you know anyone who has done a Lightning Process course, ask them about their
personal experience of the Process and contact me if you have any specific questions
you would like to discuss.
1. Have you read the book/listened to the audio book/had the book read to
you? Yes
No
If you feel that you are ready to take the course, then please complete this form.
Before you are accepted on to the course I will contact you by phone to introduce
myself, to ask you some questions about your understanding of the Lightning
Process and to answer any questions you may have. Through discussion with you,
we will assess whether this training programme is right for you at this time and
provide you with any pre-course coaching required to help you prepare yourself for
the training.
About the Lightning Process Course
The Lightning Process is an empowering training programme which teaches you how
you can influence your health and life using techniques based on the way the brain
and body interact. It involves specific steps using movement, posture and coaching
which can be tailored to the abilities of the individual if needed.
The course usually takes place in small groups and is carried out over 3 consecutive
days. Each day is approximately 3-5 hours including breaks.
On completion of the course you will receive an attendance certificate.
Expectations:
What you can expect from me, your practitioner:
 I will work with you with care and integrity
 I will follow the approved ethical training structure
 I am completely committed to you and your success
In return, what I expect of you:
 That you are ready and committed to fully participate and engage in the
training and be ready for interesting and fascinating approaches to change
2. Are you willing to attend and participate in the discussions, training and
coaching sessions? Yes No Maybe
3. Personal History
How would you describe your illness/symptoms/issues? (Include medical
name/diagnosis if relevant)
Diagnosing Consultant/Doctor:
Date of Diagnosis:
When did your symptoms/issues begin?
How did they start?
How has this affected your life?
4. Do you feel you can influence your own health? Yes
No
Maybe
5. Do you believe you can get better/resolve your issues?
Yes No Maybe
It is important for me to know about your general state of health and health history
both physically and mentally. To help me assess your suitability for the seminar
please tell me if you have any medical or mental health issues that you have not yet
mentioned on this form. If so, please list them:
The reason I ask about your past medical history is not because I have medical
training, but I do need to know if you may need help and support in addition to that of
myself, your Lightning Process Practitioner.
Do you need wheelchair access to get to the venue? Yes
No
6. Your Lightning Process Course
What do you hope to achieve from doing the course?
When you have discovered a way to get well and resolve your issues, what would
you love to do with your life?
1.
2.
3.
4.
5.
6.
7. Do you know of someone or have you spoken to someone who has used the
Lightning Process to recover their health? Yes No
8. Have you applied to take the training before? Yes
No
If ‘No’ go to question 9
If ‘Yes’ which practitioner did you apply to?
And when?
What has changed for you since applying to that practitioner?
I may need to speak to that practitioner about your application, please confirm that
you give me permission to do this. Yes No
9. I would like to be accompanied at the seminar Yes No Maybe
As this is a personal journey, most people decide not to have someone with them
when they attend the Lighting Process course. However, it is a decision for you to
make as to whether you wish to bring a family member or friend with you. If you do
choose this, we have found that the kinds of qualities ideal for someone who attends
to support you in your learning are to be fully supportive, positive and inspiring.
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.
10. Confidentiality
The Lightning Process is a training programme, not a therapy, and there is no
requirement for you to share personal information with other members of the group,
but some people may choose to do so. Do you agree to maintain confidentiality with
regard to personal information shared by others during the training? Yes No
11. Payment Details
The training fees for taking the Lightning Process training with Alastair Gibson are as
follows:In Group Training £695.00 per person. (Scotland Courses .. an additional £150 per person for
group courses, to cover travel costs)
(There may also be additional costs depending on your
chosen location, up to £500 to cover travel costs)
One to One Training £1300.00
Many people, who are able to travel, find it more cost effective to travel to Bournemouth, where they
can enjoy a short seaside break as well. For those that are unable to do this I'm happy to travel to you.
Please contact me to discuss details.
This includes any pre-course support or coaching, your assessment, 3 half days of
training and course materials and 3 hours of follow up phone calls (to use within the
year following training).
Half the fee is payable once you have been accepted onto a course, and balance on
Day 2 of the course.
The first payment is required by making a bank transfer sort code 090150 account
05426960 A Gibson or cheque payable to A Gibson or Withinspiration and is only
payable once you have been accepted onto a course.
12. 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. It's purpose is to
train me in the tools of the Process, and I realise that simply attending will not
guarantee me any results. I recognise the changes I want can best be obtained by
fully participating and engaging in the seminars and continuing to apply it after. I am
ready and committed to do this.”
If sending the form via email, then please print your name if you would like it to
represent your signature in this document.
Signature:
Date:
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 or guardian to read through
the form and if they also agree to the terms and conditions, for them to sign the form
too.
Name:
Signature:
Relationship to applicant:
Date:
Terms and Conditions
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 we 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
All documents you receive as part of your training constitute the intellectual property
of Phil Parker and are not to be reproduced, sold or distributed in anyway.
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
The Register of Lightning Process Practitioners is registered with The Information
Commissioners Office and all information is held in accordance with the Data
Protection Act 1998.
You can decide to have your attendance certificate logged, together with your name,
certificate number and e-mail 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 expect
from members of our register
If you would like this option please check this box.
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 check this box if you wish to receive occasional and relevant correspondence
from us about this.
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.
Please send this completed form to:
Alastair Gibson : Withinspiration, 3 Brownen Road, Bournemouth, Dorset . BH91HQ
Or by email to [email protected]
Any questions please tel 01202 269972
Thank you for filling in this form. I will phone you to discuss the training and assess
your readiness to get the most out of the Lightning Process
I look forward to helping you!