WORKSHOP/CLASSES REGISTRATION FORM
Seeds for Change Wellness
105 Oak Drive Sellersville, PA 18960
email: seedsforchange@comcast.net
website: www.seedsforchangewellness.com
Phone:
(Susan Anderson) 267-377-0088
Request to Participate in Reiki Level III Master Practitioner Apprenticeship Program
Name: ______________________________________ Date: _____________________
Address:
____________________________________ ______________________ ____________
(Street) (Town) (Zip Code)
Telephone: ___________________________ email address: _______________________
Reiki Training Information:
Reiki Level I Teacher: _________________________________________________________
Year Trained: ___________
Reiki Level II Teacher: _________________________________________________________
Year Trained: ____________
How Frequently Do You Practice...:
- Working with Others Informally?
- Working with Others Professionally?
- Send Long Distance Healing?
Why Are You Interested in Moving onto Level III?
Please email or send this request to Susan Anderson
Mailing Address: 105 Oak Drive, Sellersville, PA 18960