Name *

First Name

Last Name

Phone

(###)

###

####

What is/are your main goal(s) for participating in this program? (Check all that apply) *

Develop a spiritual practice

Self-development

Sharing Reiki with others informally (non-professionally)

Sharing Reiki with others professionally

Experience spiritual community

Learn the Japanese origins of Reiki

Other

Your Chosen Investment: The actual cost of the 9-Month Program is $2,300. We offer scholarship pricing of $1,800 if investing the full price would represent a hardship for you. Please let us know your choice of investment (either can be paid all at once or spread out over the 9 months). We also offer 20% off either investment to students who enroll in groups of 2 or more. Check the appropriate box below. *

Regular Price ($2,300)

Scholarship Price ($1,800)

Group Enrollment: Regular Price (2 or more students enrolling together receive 20% off each. Please submit a form for each student.)

Group Enrollment: Scholarship Price (2 or more students enrolling together receive 20% off each. Please submit a form for each student.)

Payment Method: Once you’ve complete this form, you’ll be re-directed to Thinkific to enroll in our on-line classroom, and pay a $200 deposit to hold your spot in the program. You can choose to pay the balance in full, or spread your payments out over 9 months ($235/month for full price, or $180/month for scholarship price). Please indicate your preference below, and you’ll receive an invoice for either the balance or the first month’s installment within 1 month.

I’ll pay the balance (minus $200 deposit) in full

I’ll pay the balance (minus $200 deposit) in 9 monthly installments

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country