MCKS Pranic Healing 2020 Winter Course Registration
Student Registration Form
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Course Registration *
Please check all appropriate boxes.
Required
Name *
Print name as you want to appear on the certificate
Address *
Add street address, city, state and zip code
Telephone *
Email *
Occupation *
Date of Birth *
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How did you hear about Pranic Healing? *
Referred by
Please check the appropriate box *
Required
If you are reviewing the course, please list the date and place your Basic Pranic Healing class was taken and name of instructor.
For your safety, please answer the following questions: *
Yes
Rarely
No
Do you smoke?
Do you take drugs?
Do you drink alcoholic beverages?
What is your diet? *
Have you been diagnosed or had history of contagious diseases or other illnesses? *
If you checked yes or undiagnosed, please specify.
Thank you for your registration! We look forward to seeing you at the event.
If you have any questions, please email us at twinheartsdc@gmail.com.
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