Questionnaire

Please fill in this form with a relaxed and benevolent mind. We would like to get to know you a little bit better, so that we do not spend our precious training time for questions like the ones below.

Thank you for your time!
Richard & Neel Neubersch

Prefix *

First Name *

Middle Name

Last Name *

Address Line 1 *

Address Line 2

Address Line 3

Town/City *

State *

Zip Code *

Email Address *

Confirm Email Address *

Cell Phone *

Home Phone *

Please give us some more personal information:

Date of Birth (dd/mm/yyyy) *

Marital Status

Education

Profession *

Are you currently employed

Do you own a car
Yes No

Do you have a driving licence?
Yes No

Additional Information

For what reason do you want to become involved with Swiss Harmony? *

Do you have any special qualification/connections? (eg. hospitality, restaurant etc.) *

A short description of who you are. *

Is there any specific Area/State in the USA that you would like to be a representative in? We always aim to fulfil these wishes. Are you willing/able to travel? *

Do you have any comments, questions or requests?

* required field

I confirm that all of the above information is correct.
I confirm my participation at the free Swiss Harmony Training Class in Amherst, Mass. on June 8 & 9.

By clicking the submit button, you confirm your participation at the free Swiss Harmony Training Class in Greenfield, Mass. on June 8 & 9.