Residential Program Application

Please Read:  A program application is required with every program being offered at The Monroe Institute® (TMI) in Virginia.  Please select the program(s) you plan to attend and enter the program dates in the field provided. 

 In this form we ask for personal information that may feel intrusive to some people, e.g., birth date, weight, height, etc.  Your responses are critical to helping us meet your needs and desires.  Food items and lodging accommodations will be selected based on your input.  To help us serve you better, please answer all questions. 

 Thank you!

 Note: This application is only for programs being offered at TMI in Virginia.  Click HERE for our E-Learning program application.

Emergency Contact Details
In case of emergency contact:
Dietary and Medical Information
Please provide your dietary and medical information below:
Please note:
If you require special assistance, please contact the Registration Coordinator to inform us of your special needs by calling 434.361.1500
If the program you're attending has a take home exercise component, you will either receive a CD on the last day of your program to take with you or a mp3 file, which you may download from your TMI account in The Monroe Institute store depending on which format you choose.
Type your full name in the field above, and the date as mm/dd/yy
3 + 10 =

Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.