Course Registration Form

Dani Lama Private Lessons Application

Thanks for applying to Dani Lama's School of Divination and Energy Healing
Student Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student E-mail*
example@example.com
Mobile Number*
Courses*
Please tell me why you want to be selected as a one on one student of Dani Lama? Be as descriptive as possible and explain what you are wanting to get out of this class and what you will use this education and certification for. *Not all applicants will be accepted as space is limited. If you are interested to be placed on a waiting list please comment that below
Should be Empty:

Dani Lama Private Lessons Application