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Registration From: Inner Alchemy 6-Hour Healing Experience

Please complete this form to help us customize your experience and provide the most supportive and healing environment possible. Your responses will remain confidential.

Personal Information:

Birthday
Month
Day
Year
Which seating arrangement do you prefer? Select all that apply:

 Previous Experience with Healing Practices:

Which healing modalities have tried previously? Please check all that apply:
Do you have any food allergies or dietary restrictions? If so, please check all that apply:
What is the number one block you would like to focus on during the workshop? Please only choose one:
Emotional Block (e.g., grief, anger, fear)
Mental Block (e.g., limiting beliefs, self-doubt)
Spiritual Block (e.g., lack of purpose, disconnection)
Physical Block (e.g., pain, fatigue)
Other
What is your intuition telling you about your connecting to you soul’s purpose at this time?
Finding Clarity and Direction
Healing and Letting Go of the Past
Serving or Helping Others
Embracing Creativity and Expression
Other
Please select the service you are purchasing:
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