RESEARCH • NETWORKING • TRAINING • EARTH HEAL CLINIC • OPERATION EARTH HEAL     

Equinox group distant healing event 

22 September 2008  

Participant’s registration form

To be completed by non-member participants in this event.  Please copy and paste the form below into the body of an e-mail, complete your details, and send it to us via e-mail.  For all the info about being included as a participant in this event, please go to this link. 

If you are planning to participate as an annual member, please go to this link for info about membership.

Participant's details:

·         Items 1 - 10 are important for admin purposes, and should be completed by all participants.

·         Items 11 - 19 are not crucial for admin purposes, but give us information which may be relevant to the treatment.  Include the info you would like to send to us, and which you feel may be relevant for you at this time. All information is treated in strictest confidence.

I would like to register as a participant in the Equinox group distant healing event, I give my permission to be included in the event, and understand that I will be receiving distant healing work on 22 September.

1.      Full name:

2.      Gender (Male/Female):

3.      Place of residence - location (give nearest city, and country):

4.      Location on 22 September if different to place of residence (give nearest city, and country):

5.      Date of birth (or as close as possible. If unknown, please give approximate age):

6.      E-mail address (to which reports and feedback after the event can be sent):

7.      Number of guests I will be including for this event (if applicable - give number):

8.      I am making a donation of (give amount):        for myself and each of my guests (if applicable), totaling (give amount):

9.      Method of payment chosen (Delete which does not apply): In South Africa/Namibia: Direct deposit/internet transfer/credit card; All other countries: /Paypal/HSBC account in UK/electronic bank transfer to SA bank account/cash sent via courier/Skype gift voucher/Western Union/other

10.   Donation payment details (Date made, reference numbers etc.):

11.   Telephone number (give country and area code, followed by phone number):

12.   Skype name (if applicable):

13.   A short summary of health problems (if applicable):

14.   Medication being taken(if applicable):

15.   Surgical history (if applicable):

16.   A short summary of areas of life in which a blockage is being experienced, or where a shift of energy is needed (if applicable):

17.   Important periods and dates in my life (a short summary - include times and events which were traumatic or stressful, such as accidents, injuries, deaths, births, miscarriages or abortions, divorces, marriages, loss of job, moving home etc. If possible, give approximate dates):

18.   Any problems/challenges you would like the treatment to focus on (a short summary):

19.   My personal focus for this event: (complete this as you want to - health, relationships or any area of your life that you would like this the treatment to focus on; can be more than one focus)

Please e-mail  this form to Earth Heal by no later than 21 September.

Thank you for registering as a participant in the Equinox event on 22 September.

We look forward to working with you, and will send a confirmation e-mail to you shortly.

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The Earth Heal Geoharmonic Research Project

is based in Cape Town, South Africa and Praia do Frances, Brazil

Email: earthhealadmin[at]gmail.com

Blog: http://earthheal.blogspot.com/