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Registration form for the 3-day Consciousness Healing
Yes! I love to receive a 3-day Consciousness Healing:
First name(s) (as in your passport)*
Surname (as in your passport)*
Date of birth*
Place of residency*
Preferred starting date of the healing
Preferred starting time of the healing, including your time zone (the healing takes +/- 30 minutes)
Phone number
Email adress
Business name
Additional comments
Register & Pay
* This data is only used to activate the Consciousness Healing
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