Group Past Life Regression Workshop Registration Form

Date:  1 May 2010                  Time: 9.30 am - 5.00 pm

Full Name Gender Male Female Age E-mail Address Mobile Phone / Telephone Address Have you had any past life recall? Yes No If you answered Yes, what method enabled the past life recall? Dreams Hypnosis Meditation Spontaneous Recall Triggered Recall Past Life Regression by facilitator Past Life Regression Tape / Audio CD Others Have you ever experienced a past life regression session? Yes No Have you ever experienced a hypnosis session? Yes No Name a regression goal you would like to experience Do you have any medical condition? Yes No If yes, please explain Are you on any medication / prescribed drugs? Yes No If yes, please explain I have read books / literature on the following topics Past Life Regression Reincarnation Life Between Lives Regression Future Life Progression None of the above I will transfer / bank-in the payment into the following bank: Hong Leong Bank: 196-00-00437-3 (LIFE INSPIRATIONS) Maybank: 114393069166 (SELINA CHEW MAY LIN) Amount Normal Fee: RM280 each Early bird: RM250 each Powered byEMF Email Forms