Enrolment Form for level 3
Full name
(as required on the certificate)
Date of Birth :
Male / Female :
Residential Address :
Phone/ Mobile Nos. :
E-mail Address :
Profession : Designation :
Name of Organisation :
Are you practicing the Reiki 1 & 2 tools ? if yes,
Write in Brief what changes have you experienced in your life
Declaration Form

I am participating in this programme of my own free will and declare that I am physically and mentally fit to participate in the workshop.

I am enclosing Cash
Place :
Date :