Space is Limited in all Workshops to provide specialized attention.
Register EARLY to ensure your space.

PLEASE MAIL, e-MAIL OR FAX THIS FORM TO CLEAR LIGHT ARTS, ADL
Rev. Dr. Nancy Nester
Post Office Box 1500, Cleveland, Ga 30528
Tel: 706-865-0322 (ofc), Fax: 706-223-0291
CONTACT US

Name: _________________________________________________________________________

Address: _______________________________________________________________________

City: _______________________________________ State: ___________ Zip: ______________

Daytime telephone: _______________________________________________________________

Evening telephone: _______________________________________________________________

Fax: __________________________________________________________________________

e-mail: ________________________________________________________________________

Have you experienced a REIKI individual or group session? If yes, feel free to detail your experiences.

_______________________________________________________________________________

_______________________________________________________________________________

What brings you to your interest in learning REIKI?

_______________________________________________________________________________

_______________________________________________________________________________

Which Level of REIKI are you planning on attending? ______________________________________

If your interest is REIKI Level Two or REIKI Level Three-Advanced Practitioner, please provide the following:

REIKI Level One completion date:_____________________________________________________

Name of REIKI Master who attuned you to REIKI Level One: ________________________________

REIKI Level Two completion date: _____________________________________________________

Name of REIKI Master who attuned you to REIKI Level Two:________________________________

What course date are you planning on attending? __________________________________________

Will you require residential accommodations (lodging)? ______________________________________

Registration Deposit required for all workshops: $75.00

METHOD OF PAYMENT

_____CHECK_____MASTERCARD _____VISA ______PayPal

All credits card orders will be charged through our business name: CLEAR LIGHT ARTS, ADL.
To pay via PayPal, please use the 'DONATE' button on the homepage at: www.ClearLightArts.org OR www.KenPage.com
Upon request, tuition paid to our 501(c)(3) not-for-profit organization will receive a tax deductible receipt for the full tuition price.
Space is limited in all workshops to ensure specialized attention.

Credit card number: _______________________________________________________________

Exp. Date: ____________

Security digits (3-digit Visa/Mastercard/Discover on back) (4 digit American Express on Front) _______

Name as it appears on the credit card: __________________________________________________

Signature: ______________________________________________________________________

COPYRIGHT © CLEAR LIGHT ARTS, ADL., Heart & Soul Healing, HSH, Multidimensional Cellular Healing, MCH, Living Light Breath, INscension, The Third Eye of Horus Mystery School, Hands of Quan Yin, Blended Energy, Bio-Energetic RePatterning, are all trademarked names belonging to Ken Page, Rev.Nancy Nester and Clear Light Arts, ADL. All text, graphics and contents© Clear Light Arts, ADL, unless otherwise noted. Use purpose must be granted by the copyright holder. Unauthorized use, alteration, transformation or reuse is strictly prohibited.