Course Signup Form — Conscious Impact

Please fill out this form to let us know that your are interested in attending one of our courses in Nepal. This is only to show interest and open communication between us. Once you have filled out the form, we will reach out to you directly to discuss further details.

Thank you for your dedication to learning the skills needed to make this world a better place!

Name

First Name

Last Name

Email Address

How did you hear about Conscious Impact?

(Friend that volunteered with us? Saw on Facebook or Instagram?)

Are you already in communication with anyone on our team?

If so, whom and over which platform (email, facebook, or instagram).

WhatsApp Number

(If you do not have a WhatsApp number, leave blank and answer the next question)

If you do not have WhatsApp, what is the best way to call you over the internet?

Facebook, Zoom, Skype, etc. Some countries are too expensive to call from Nepal without the internet.

Birthdate

YYYY

Current Location & Timezone

Birth Country

Which course(s) are you interested in attending?

Earthbag Dome Training Course (November 14th-26th, 2022)

Introduction to Natural Building (January 5th-12th, 2023)

Other

During which dates do you plan to stay at the Conscious Impact camp?

(Will you come for the course only, or do you plan to volunteer for additional days outside of the course?)

What are your expected arrival and departure dates into Kathmandu?

(If you don't know, you can also write that. Thanks!)

Will anyone else be joining you on your trip?

Why are you interested in joining this course in Nepal?

What skills, interests and/or experiences do you have that you feel are relevant to this course?

No experience is required. This is only to help us better know you.

What specific expectations and learning goals do you have for attending this course?

This helps us understand if this course is right for you

Any other information you would like to share? Comments? Questions?