| Full Name
|
| Mailing Address
|
| City
State/Providence
|
| Zip/Postal Code
Country
|
| Home Phone
Cell Phone (Optional)
|
Email Address (this is required if you wish to receive the newsletter, announcements of upcoming events,
and special notices): |
Help Us To Serve You Better. Please list your special interests and hobbies:
|
In order of preference, please list the departments in which you are interested by placing a number at the
end
of the title. (Example: Business 1 Philosophy 2, Youth 3, and so forth. |
| Philosopy
Sciences |
| Youth
Public Services
|
| Business
The Arts
|
| Healing Arts
|
|
I wish to be a member of the Distant Healing Council. |
Do you have any special talents, skills, or knowledge you wish to share with others, and
if yes, what are
they?
|
What experience or education do you have in the areas of your special talents and/or
knowledge?
|
(Optional) Educational Background:
|
If you are under 18 please state your age.
If under 18, we are required to have your
parent or legal
guardian’s written permission for you to participate in the activities of the Institute.
Please mail this form,
along with your parent or legal guardian’s written permission for you to receive
e-mail and participate in the
on-line activities of the Youth Department. |
| |