Mutual Support Information form

Mutual Support Team.

If you have taken the Theta Healing basic training class,
you are invited to participate in our mutual support team.

Please print clearly.

Your Name: ___________________________________________________

Your Phone Number: Area Code __________ PH # ___________________

Street Address __________________________________________________

City ________________________________State ___________ Zip ______

Add my address to the mutual-support list ( ) Keep my address private ( )

E-mail Address: _________________________________________________

Do you have a website? Yes ( ) No ( )

Website Address: ________________________________________________

Are you willing to exchange website links? Yes ( ) No ( )

I am interested in:

1- Mutual-Support Gatherings ( ) 2- Phone Practice Sessions ( )

3- Conference Calls ( ) 4- Blogging ( ) 5- Social Gatherings ( )

Add any Comments or additional information: _____________________________

_____________________________________________________________

Signature: ____________________________________________________

Date: _________________________________________________________

http://www.ThetaHealing101.info/th-027-mutual-support-Form.html