RSVP for Healing Clinic @ Bailey's Cafe Saturday, November 4th 1:30 to 5:30

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please complete the following form to RSVP for the Healing Clinic and to sign up for ONE (1) complimentary 25-minute private session (between the hours of 1:30 and 3:30) with ONE (1) of our practitioners--Kadeem Alston Roman, Shawnee Benton and Robin St. Clair. The second half of the clinic will be a group experience with each of the healers presenting different modalities of healing

Email *

Full Name *

Phone Number *

You Have A Choice of ONE (1) Private Session. Please Select ONE (1) of the Healers and ONE (1) of the Time Slots

Kadeem Alston Roman: Neuro-linguistic Programming, Energy Medicine, Aromatherapy (select one time slot)NOT AVAILABLE ALL TIME SLOTS FULL

1:45pm to 2: 10pm NOT AVAILABLE

-2:15pm to 2:40pm NOT AVAILABLE

-2:45pm to 3:10pm NOT AVAILABLE

-3:15pm to 3:40pm NOT AVAILABLE

Clear selection

Shawnee Benton: Spiritual Healing Using Psychodramatic & Intutitive Coaching (select one time slot)

1:45pm to 2:10pm NOT AVAILABLE

-2:15pm to 2:40pm

-2:45pm to 3:10pm NOT AVAILABLE

-3:15pm to 3:40pm NOT AVAILABLE

Clear selection

Robin St. Clair: CYCLEBREAKER - holistic T.O.O.L.S. and strategies for Breaking Cycles. (select one time slot)

1:45pm to 2:10pm NOT AVAILABLE

-2:15pm to 2:40pm

-2:45pm to 3:10pm NOT AVAILABLE

-3:15pm to 3:40pm NOT AVAILABLE

Clear selection

How did you hear about the Healing Clinic?

Friend

Family Member

Social Media

Other:

Clear selection

What parts of the event will you be participating with?

Private Session ONLY

Group Session ONLY

Private & Group Session

Other:

Clear selection

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Bailey's Cafe. Report Abuse

Forms