• This link for info about membership 
• This link for how to register as an annual member.

I would like to accept your invitation to be included as a non-member participant in the 25 July group distant healing event!

Items 1 - 10 are important for admin purposes and should be completed by all participants.

Items 11 - 19 are not crucial for admin purposes, but give us information which may be relevant to the treatment.  Include the info you would like to send to us, and which you feel may be relevant for you at this time. All information is treated in strictest confidence.

1. Full name:
2. Gender (Male/Female):
3. Place of residence - location (give nearest city, and country):
4. Location on 25 July (give nearest city, and country):
5. Date of birth (or as close as possible. If unknown, please give approximate age):
6. E-mail address (to which reports and feedback after the event can be sent):
7. Number of guests I will be including for this event (if applicable - give number):
8. I am making a donation of (give amount):        for myself and each of my guests (If applicable), totalling (give amount):
9. Method of payment chosen (Delete which does not apply): In South Africa/Namibia: Direct deposit/internet transfer/credit card; All other countries: HSBC account in UK/electronic bank transfer to SA bank account/Paypal/cash sent via courier/Skype gift voucher/Western Union (go to this link for more info about donation payment options)
10. Donation payment details (Date made, reference numbers etc.):
11. Telephone number (give country and area code, followed by phone number):
12. Skype name (if applicable):
13. A short summary of health problems (if applicable):
14. Medication being taken (if applicable):
15. Surgical history (if applicable):
16. A short summary of areas of life in which a blockage is being experienced, or where a shift of energy is needed (if applicable):
17. Important periods and dates in my life (a short summary - include times and events which were traumatic or stressful, such as accidents, injuries, deaths, births, miscarriages or abortions, divorces, marriages, loss of job, moving home etc. If possible, give approximate dates):
18. Any problems/challenges you would like the treatment to focus on (a short summary):
19. My personal focus for this event: (complete this if you want to...health, relationships or any area of your life that you would like this the treatment to focus on; can be more than one focus) 

Please e-mail this form back to us as soon as possible, and no later than 24 July, 2008.

 

Thank you for registering as a participant in the 25 July 2008 event.

We look forward to working with you, and will send a confimation e-mail to you shortly.

 

The Earth Heal Geoharmonic Research Project is based in Cape Town, South Africa and Alagoas, Brasil

Email: earthhealadmin@gmail.com • Earth Heal blog: http://earthheal.blogspot.com/