Street Address:

City, State, Zip Code (or Province, Country, etc.):

E-mail Address:

Home Phone:      Business Phone: 

Gender:     Age:     Marital status: 

Why are you seeking Reiki training?

Have you had prior Reiki training?
Yes          No 

If yes, to what Degree(s) have you been trained and attuned:

Name and contact information of former Reiki Master:

Date(s) of your attunement(s):

Present occupation:

Do you have other training or work experience in the healing arts?
If yes, please describe:

How did you learn about Carol Denicker's Reiki training programs?

Indicate with an "X" the level of training you are applying for:
Reiki I & II:   Tuition: $390.00
Reiki I:   Tuition: $195.00
Reiki II:   Tuition: $195.00
Reiki III/Master:  Tuition: $490.00
Reiki I, II, or III/Master (Private Training - Weekdays Only):  Tuition: $300.00 per day

Indicate training dates applied for:

Registration requires a deposit of $100.
Full payment is due 10 days prior to class date.

Indicate with an "X" your choice of payment method:
Visa:    MasterCard:    Amex:     Discover:    Check:    Money Order: 
 

Indicate payment amount authorized:

 Send checks & money orders to: Carol Denicker, Holbrook Wellness Center, 5000 Expressway Drive South, Holbrook, NY 11741

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