Marin Institute For Projective Dream Work (MIPD)

Application Form

Please fill out the application in full and mail a hard copy, together with your non-refundable application fee of $50.00 ($53 if using Paypal).

It would also be helpful if you include a small picture (snapshots are OK).

If Jeremy has had a conversation about MIPD with you at a Workshop realize that he may not remember all the details. Please use a cover letter with your application if there are things you would like to remind him of.

MIPD/Jeremy Taylor, Director
736 San Pedro St
Fairfield, CA 94533

If you have questions, email (kathryntaylor123@comcast.net) or call 707/422.9308.

Name:

Street Address:

City:

Zip:

Phone:

Email address::

Age:

Gender Identity:

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1) Do you have any ailments, impairments, injuries, Illnesses, or disabilities, physical or mental, that we should be aware of?









2) How did you hear about/become interested in the MIPD Professional Projective Dream Work Training Program?









3) What books, workshops, classes, etc., have influenced you and your interest in dreams and exploring their deeper layers of meaning?









4) What sort of religious/spiritual training/education did you get as child?








5) What other professional credentials do you already possess, or are in the process of acquiring?








6) Have you ever been convicted of any crime, (other than minor traffic violations where no physical injury was involved)? If so, please give general details.








7) What experience have you already had, working with and exploring your own and other's dreams?









8) What do you hope to gain from participating in the MIPD training program?









9) What ideas, if any, do you already have about giving your unique gifts as a dreamer and professional dream worker to the world?