Form
Reiki Certification Registration Form- Reiki 1- Reiki 2 - Reiki Master- Reiki Teacher
Name (how you want it presented on your certificate)
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First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What Reiki Certification course are you registering for? Please only chose the course you are registering for right now.
*
Reiki1
Reiki 2
Reiki 3
Reiki 4
Have you previously completed any Reiki training?(a copy of the certification will be required if you are applying for Reiki 2 or higher)
*
Please upload a copy of your most recent and previous certification (only required for those registering for Level Two or higher)
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How many Reiki session have you experienced before?
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None
1 to 5
5 to 10
10 +
Why do you want to be certified in Reiki?
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What are you personal goals for taking this Reiki certification course?
*
Are you currently practicing any other healing modalities? If yes please list:
*
A non-refundable deposit of $50 is required upon acceptance into this course. Once accepted, you will receive a separate email with an acceptance confirmation and more details as well as a payment link. The remaining balance for the course will be due 3 days prior to the class start date.
*
Please Select
I agree and understand
I do not agree or understand
Date
*
-
Month
-
Day
Year
Date
I understand all the information in this form, and I understand this is NOT acceptance in this course and I will receive a separate email once I am accepted.
*
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