MCKS Pranic Healing 2020 Winter Course Registration
Student Registration Form
Course Registration *
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Name *
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Address *
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Telephone *
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Email *
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Occupation *
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Date of Birth *
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How did you hear about Pranic Healing? *
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Referred by
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Please check the appropriate box *
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If you are reviewing the course, please list the date and place your Basic Pranic Healing class was taken and name of instructor.
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For your safety, please answer the following questions: *
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Rarely
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Do you smoke?
Do you take drugs?
Do you drink alcoholic beverages?
What is your diet? *
Have you been diagnosed or had history of contagious diseases or other illnesses? *
If you checked yes or undiagnosed, please specify.
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Thank you for your registration! We look forward to seeing you at the event.
If you have any questions, please email us at twinheartsdc@gmail.com.
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