REIKI Intensive Application Form

Basic Quantum-Touch Workshop
Application/Registration Form:

Please note that this is not an on-line registration form. In order to register for this class, please copy this entire page and paste it into an e-mail which you address to gundi@healingguidance.net. Then fill out the blanks and send off your e-mail. As soon as we have received your e-mailed registration, we will initiate payment by crediut card via PayPal, if you request this payment method.

I am applying to attend the 2-day Basic Quantum-Touch Workshop on ________________
held at: _________________________________:

Name: _________________________________________________

Address: _________________________________________________

City: _________________________ Zip: _____________

Phone: ________________________ Fax: _____________

E-mail: _______________________

Tuition: $345.00 ($295.00 "early registration" if paid in full 21 days before the seminar date if seminar is at Sea Ranch or at Truckee/Tahoe-Donner; 14 days if Seminar is held at Sunnyvale).
Review fee: $175.00 ($150 early registration).
A deposit of $200 will hold your space.

Tuition:

|___ | I wish to pay by credit card (in a secure manner through PayPal -- no PayPal account required).

|___ | I will (snail) mail my check # ______ in the amount of $___________ made out to Adelgund Heinemann to secure my place in the workshop.
(The mailing address will be provided upon receipt of this e-mail; payment by credit card is requested if the seminar date is within 14 days).
|___ | I have previously attended a Basic Quantum-Touch Workshop and qualify for the review fee.

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Housing:

For Workshops taking place at Sea Ranch or Truckee/Tahoe-Donner:

|___ | I have also enclosed my separate check # _________ in the amount of $___________ (min. $100.00) per person toward housing in a Sea Ranch/Tahoe-Donner home. I understand that Sea Ranch/Tahoe-Donner housing will be on a first come/first served basis) and that payment of the balance of the housing fee will be due upon my arrival.
I prefer |___ | single ($170) |___ | double ($130) occupancy and will call 408-472-9037 (Gundi) for reservation details.
|___ | I am interested in staying an additional night (i.e., on Sunday) at the Sea Ranch/Tahoe-Donner accommodation at a nominal extra charge of $60 ($95 single room).
|___ | I am interested in arriving one day early (i.e., on Thursday) at a nominal extra charge of $60 ($95 single room).

|___ | I will arrange for housing by myself.

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I understand that registration is on a first come first served basis and that the lodging fee does not include meals. I also understand that I will receive full refund, less a handling fee of $50, should I cancel 15 or more days prior to the seminar date.

_________________ _________

(Signature) (Date)

If you wish to e-mail this application, highlight the entire page, copy, and paste it into the body of your e-mail to gundi@healingguidance.net; then fill it out and press the "send" button. In that case, a signature is not required -- just type your name into that space.

You may also fax the application to: 408-730-1441

Last updated on 7/7/10