Class Interest Survey:
Page 1 - General

About You

Instructions: Please provide some general information about you. This information will NOT be linked to a name or email address, so is completely anonymous.

What is Your Gender?

      

What is your Sexual Preference?

      
    

Relationship Status

      
  

What is your age? (enter 0 for No Answer)

City of Residence

State of Residence

Postal Zip Code (5-Digit)



Your Interests

Instructions: Please indicate your level of interest in taking Classes in the following topics using a scale from 1 to 5 with 5 being Very Interested, 3 being Possibly Interested/Unsure and 1 being No Interest at all.

Traditional Tantra Yoga

          

Western Tantra Sacred Sexuality

          

Reiki Training

          

General Massage Classes (non-erotic)

          



Please do not go backwards to change your answers. Once each page is submitted, it cannot be resubmitted.
“…our most intimate acts of loving another person
also signify our feeling of oneness with the sacred.”
Frederic and Mary Ann Brussatt, Spiritual Literacy