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Registration: Intensive Healer Training Retreat in Costa Rica

First name*

Last name*

Address*

City*

Province or State *

Country*

postal or ZIP code*

Email*

Phone*

Emergency contact *

Emergency contact phone number *

Have you taken the Level 1: Qi Activation Course?*

have taken Level 1 Qi Activation Course

I need to take Level 1: Qi Activation (please contact me to set up class)

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