Name *

First Name

Last Name

Phone

(###)

###

####

Are you a Reiki Practitioner or Student of Reiki? *

Yes

No

Do you teach Reiki? *

Yes

No

Do you have a professional practice - public or non-profit? *

Yes

No

Do you want to be listed on our Support page? *

Yes

No

If Yes, do you want to be listed as

Individual

Business

Organization

Do you have experience lobbying? *

Yes

No

Would you like to be an organizer or team leader? *

Yes

No

Would you like to host a Reiki Unified Presentation for your Reiki Community? *

Yes

No

Possibly