Personal Support Energetic Program Application (denniz.org)
Thank you for your interest in joining my Energetic Youth Programs that are designed to help at least 2 billion people.

Some of the questions may seem unusual, but since I always work with bio-energetics, energy fields, and meta-energy levels, everything in this form is connected to energy. Therefore, please do not interpret this as a medical diagnosis or treatment.

 Questions marked with a red asterisk (*) are mandatory and must be answered.  
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Email *
Full Legal Name *
Date of birth (day, month, year - e.g., 08 August 1978) *
Contact Number
Phone Format: +[Country Code] - ([Area Code]) - [Phone Number]   *
Your Website / Social Media (separated by commas)    *
Address *
City *
State or Province *
Country *
Zip or Postal Code *
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