Reiki Energy Medicine
Online Registration Form for Reiki Classes, Hypnotherapy
and Other Workshops.
 
 Please note: some insurances have a Health Awareness or Education Option and they may reimburse for courses and sessions.  Check with your provider for more information.
Do Not Use Your Enter Button Or Form Will Prematurely Be Submitted.
  First Name     
  Last Name     
  Mailing Address     
  City     
  State     
  Zip     
  Email Address     
  Confirm Email Address     
  Telephone     
  Please Select Your Class  
  Reiki One $75     
  Reiki Two $85     
  Past Life Regression , One Hour Group Hypnosis Session  $35     
  Weight Loss with  Hypnosis - Group $45     
  Meet Your Spirit Guides  Group Hypnosis $45     
Healing Grief  Group Hypnosis $35   
 Quit Smoking with Hypnosis - Group $35 
Learn How To Meditate Workshop $50  
Sleep Soundly - Group Hypnosis $45   
The Power of Manifesting
A Darn Good Life $80
 
.
 
 :

 
Conquering Fears of Dental  Procedures - Group Hypnosis  - $35

 

Reiki One For Teens  $75 or  $50 for  Younger Children

Two or more teens (bring a friend): $50 each

 

 
EFT Level One Seminar $100
 

Day of Healing $75

 
For Reiki Classes, We Offer A $10 Discount For Seniors (65 years or older), Students and Hospice Workers.  Patients of Family Chiropractic of Merrimack are also offered discounts for many classes and sessions.  Please indicate you are a Patient of the office when you complete this registration in the "Comments" area below.
Registration is not complete until tuition is received in the mail, as space is limited and reservations are necessary.  Clients with limited funds are encouraged to contact us to make payment arrangements.  There are many options we can discuss that will enable you to have a private session or take a course.   Credit cards are now accepted.  Please call (603) 483-0132 to process your card information or  Make Check Payable to Diane Gelinas and Mail to:
 
Diane Gelinas
A Step Forward
104 Douglas Drive
Candia, NH, 03034

 

  
 

I am a student, Hospice worker or senior and Qualify For A $10 Discount for Reiki classes

  

 
Gift Certificates Are Available
  The Above Class Is  A Gift  
  Please Send Me A Gift Certificate  
  The Gift Certificate Is For    (name)  
 
This Gift is For :
Reiki One Reiki Two
Other  Please Describe
 
  Please Mail Certificate To Different Address  
  Street Address Where Certificate Is To Be Mailed    
  City     
  State     
  Zip     
If You Are Interested In Private Hypnotherapy Session Please Indicate Below
  Please Send Me More Information On:  
  Weight Loss Smoking Cessation  
  Conquering Fears Past Life Regression  
  Meet Your Spirit Guides and Angelic Guides  
Individual, hypnotherapy sessions generally last an hour and are $75 a session. $A $10 discount is available for students that have completed a Reiki Certification class with me and for individuals 65 years or older.
Please Tell Us How You Found Our Site
  Referred By A Friend Already A Client  
  Brochure At Other:  
Link From Other Web Site   Site Name:
 
 
Additional Comments or Questions:

Registration Fees Are Necessary in advance to reserve a space in a session or class. Tuition is non-refundable after registration deadline, however, transferable to future workshops.  Tuition is also refundable if the course is cancelled or rescheduled to a date you can not attend.

 

Once All Information Is Completed Please Select Enter To Submit Form