Name *

First Name

Last Name

Phone incl. country code *

(###)

###

####

Do you meet the requirements? *

Please select all that apply - if that's not all of them this might not be for you:

I'm an entrepreneur, freelance, leader or work in tech.

I'm not seeing this session as an opportunity to sell.

I'm open to exploring both my personal and professional life, this is a current priority.

I'm interested in a one-year paid Breathlife Micro-Community Membership.

Contraindications *

As we'll be doing somatic work it's fully safe to do so. Do you have any of the following medical conditions? Please check all that are relevant. If none, please select "None of the above". If you prefer not to say in a form do feel free to reach out directly to steven@breathlife.space

Unmanaged diabetes or thyroid condition

Cardiovascular disease

Detached retina or Glaucoma

Diagnosed bipolar or schizophrenia

Brain or stomach aneurysm

Pregnant

Epilepsy

High blood pressure

None of the above