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*First & Last Name:
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*Street Address:
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*City:
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*State:
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*Zip Code:
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*Home Phone:
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Work Phone:
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Mobile Phone:
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*Email Address:
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*Your name for your Reiki certificate:
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Are you okay with having a dog in class for animal demonstration/practice?
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Yes, a dog in class is fine with me.
No, I do NOT want a dog in my class.
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Level 1 Class Date:
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Level 1 Payment Method:
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Level 2 Class Date:
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Level 2 Payment Method
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Level 1-2 Full Weekend Dates:
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Full Weekend Payment Method:
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Master Practitioner Class Dates:
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Master Practitioner Payment Method:
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Master Teacher Class Date:
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Master Teacher Payment Method:
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