Beamer Light Pen Practitioner Level 1

Opening the Portals of Light | February 27 - March 1

Full Name

Email

Phone

Birthday

Month

Day

Year

Address

Emergency Contact

Emergency Contact Name

Emergency Contact Phone

Energy Work Background

Experience Level

Beginner - New to energy work

Intermediate - Some experience with chakras or chromotherapy

Advanced - Experienced practitioner

Have you used other energy work modalities?

Yes

No

Health & Well-being

Are there any health considerations (physical, emotional, or mental) that may affect your participation?

Yes

No

Intentions and Goals

Class Deposit & Payment

💰 Deposit: $100 due with registration

📅 Balance due by: February 16

Payment Instructions:

Check, Venmo, Zelle accepted
Deposit is non-refundable within one month of class

I will pay the $100 deposit via:

Check

Venmo

Zelle

Waiver and Consent

⚠️ Important Information:

This class is educational only and not medical treatment
Participation is voluntary
You may step away at any time
Deposit is non-refundable within one month of class

I understand and agree to the terms stated above, including that this is educational only and not medical treatment, and that my deposit is non-refundable within one month of the class.