Please Print Clearly

 

Return completed copy with your deposit/full payment made payable to: Elizabeth Ohmer Pellegrin

Call (504) 388-2356 for mailing address or for any questions

 

 

Dates of class

 

_____________________________________________________________________

 

How did you hear about this class?

 

_____________________________________________________________________

 

 

Name ______________________________________________________________ 

(as you would like it to appear on your completion certificate)

 

Birthdate _________________

 

 

Name you like to be called________________________________________________________________

 

 

Street Address

_______________________________________________________________________

 

 

City _____________________________________________________

 

State_____________ Zip ______________

 

 

Phone __________________________________

 

Cell Phone ____________________________________

 

 

Email Address

 

___________________________________________________________________________

 

 

 

Please make checks payable to Elizabeth Ohmer Pellegrin

 

Deposit or full payment enclosed $ _______________

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cash       check       money order       credit card       paypal 

 

I am registering for the following sessions/class:

(please circle all that apply for your registration)

 

Reiki Session (1hour 15 min)

1st Degree Reiki Class 1st Degree Reiki Class - Reviewer

2nd Degree Reiki Class 2nd Degree Reiki Class - Reviewer

Counseling of Reiki Students on the Path of Personal Practice (self, family, friends)

Counseling of Reiki Students on the Path to Public Practice (clients)

Counseling of Reiki Students on the Path to Mastery (considering the possibility of mastership)