Reiki-Wales Booking Form

If you wish to book your place on one of my workshops please simply print and complete this form, enclose your deposit and post to me to secure place and dates.


CONTACT DETAILS (PLEASE PRINT) ________________________________________________ NAME ________________________________________________ ADDRESS ________________________________________________

________________________________________________ POSTCODE ________________________________________________

TEL: ____________________ FAX:___________________

E-MAIL __________________________________________

I WOULD LIKE TO A PLACE ON THE FOLLOWING WORKSHOP:

(Please tick and state preferred date):

REIKI ONE + Japanese Techniques
( )
Date:
Cost: £150

REIKI TWO + Japanese Techniques
( )
Date:
Cost: £150

Reiki Master Practitioner + Japanese Techniques
( )
Date:
Cost: £250

Reiki Master Teacher + Japanese Techniques
( )
Date:
Cost: £400

Japanese Techniques part 1 (for Reiki 1, 2 & Master Practitioners)
( )
Date:
Cost: £60 (1 day course)

Japanese Techniques part 2 (for Master Teachers)
( )
Date:
Cost: £60 (1 day course - Having completed part 1 )

Refresher Classes
( )
Date:
Cost: 50% course cost.

PAYMENT:

Deposit for all courses is £25.00 and is non-refundable. Please make cheques payable to 'Lorraine Rees'.

PREVIOUS REIKI COURSES:

Reiki Courses already completed:

Reiki Master 's name:

Reiki Master's Address:

Date course completed:

(If you have already completed a reiki course(s), please include copy of certificates).

PERSONAL INFORMATION:

Date of Birth:

Occupation:

Marital Status:

HEALTH:

Are you suffering from any acute/chronic condition at present (mental, emotional or physical)?

If so, please give brief description:

Have you ever been hospitalised or have you ever been, or are currently, in therapy or psychiatric care for a mental disorder? If so please describe:

Are you taking any form of medication? Please give details:

SPECIAL REQUIREMENTS:

Please inform us below if you have any dietary eg vegetarian or other special requirements.

ACCOMMODATION:

Please do/don't fax/post/e-mail me a list of available hotel and B&B accommodation.

DECLARATION:

I have read and understood the details of the course. I am of legal age and in the consideration of my acceptance as a participant in these Reiki classes, I, for myself, my executors, administrators and assignees do hereby release and discharge Lorraine Rees and any employees, assistants, guest speakers or members of her support team from all claims of damages, demands or actions whatsoever in any manner arising from or growing out of my participation in these classes. I understand that my deposit is non refundable once I have been accepted on the course and that the full class fee paid by me is non refundable if I cancel less than 14 days prior to class date. I agree that the materials and content are confidential and that I will not teach this class or use any of the content or materials without written permission.

Signed _________________________ Date____________

Please return the completed form with deposit/full payment to:

5 Y Garreg Lwyd, Llanedi, Pontarddulais,
Swansea. SA4 0ZL

Tel: 01792 881600
Fax: 01792 885368