Soul Journey: Roots: Darkness and Light Registration Form
10 Month Immersion Program: March - December 2019 * 6:00-8:30 p.m. Jamaica Plain.
Dates: (1st Thursdays): 3/7, 4/4, 5/2, 6/6, Summer Retreat: July 19-21, 9/5, 10/3, 11/7, 12/5
(There will be three additional Ceremonies:, dates to be determined. Six private sessions to be arranged individually)
Email address *
Name: *
Phone Number *
What are your intentions in taking this soul journey? *
Envision yourself a year from now. What changes can you imagine? (in your work, relationships, physical, emotional, and spiritual self, etc.)? *
What are the main patterns in your life that are stuck or no longer serving you? *
What experience do you have with Healing modalities, meditation, therapy, etc.? *
Do you have any specific needs of which you would like us to be aware? (Scent-sensitivity, prefer a chair, sight or hearing needs, allergies, etc.)
Emergency Contact Information: (please include name and phone number): *
Payment Options: Paypal to or send check to Tracy Rich, PO Box 302141, JP, MA 02130 *
Describe Payment Plan Offer to discuss:
Add any questions or information that would be helpful to you at this time:
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service