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.
“To achieve full self-realization we must connect our sexuality
physically, emotionally, mentally and spiritually.”
Dr. John C. Pierrakos, Eros, Love & Sexuality