In-Person Training Request Form

balancing elephants breathing coach Stephanie esser

First Name (Main Contact)

Last Name

Email

Phone/Mobile

Business/Organization

Address Line 1

Address Line 2

City

State

Zip Code

Number of People Attending

Date / Time Preference *optional

Type of Service/Training

1-on-1 Breathwork Coaching

Live Workshop

4-Week Breathwork Program

Other

Service Format/Length of Service

Do you have a budget for this service?

Briefly describe your goals for the service or training

Anything else we should know?

Would you like

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Help your child learn how to manage stress and improve
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kids breath well to BE Well

Help your child learn how to manage
stress and improve focus skills with the
BE Buddy® – a mindful tool to help kids breath well to BE Well

first name

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*not to be combined with other discounts