E-Mail:	
First Name:  
Last Name:  

Which Reika level you want to take:
Reiki Level 1
Reiki Level 2
Reiki Level 3


Are you ready to begin class?:
Yes
No


If your answer was no, when do you feel you may be ready? :

Your phone number (with country, city, area codes): 

Would you like me to telephone you about Reiki? :
Yes
No


Best Day of the week and Time to call you:

If you would like to meet online, please let me know your prefered Immediate Message program below 
and your screen name or number.

ICQ# : If you have one.

AOL screen name : If you have one.

MSN  : If you have one.

Yahoo : If you have one.

Alternate E-Mail:	

I need to know what state you live in, so I know which time zone you are in. 

Address: 



City: 
State: 

Zip/Country code: 

If you are Ready to Join in a Reiki Class Now...

What is the best date and time for you to receive your attunement/initiation? 

please list this in the box below.

Please feel free to ask any questions that you have.
Please Note any comments or Questions here as well. Thank You.
  
Please retype this number "5338":