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Long Island Reiki Connection

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 APPLICATION  




Long Island Reiki Connection
Click for printable application
PRIMARY PRESENTER/CONTACT:

NAME: ______________________________________________________________________
ADDRESS: ___________________________________________________________________
                     ___________________________________________________________________
PHONE:  _____________________________________________________________________
E-MAIL : _____________________________________________________________________  

 CO-PRESENTERS:

       NAME                                    ADDRESS                     TELEPHONE                  E-MAIL
1) ____________________________________________________________________________
2) ____________________________________________________________________________
3) ____________________________________________________________________________

 
WORKSHOP TITLE (As it will appear on website/publications)
 _______________________________________________________________________

 

WORKSHOP DESCRIPTION: (for publicity and/or pre-registration)  


______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
 
___________________________________________________________________________________

Maximum number of participants: ____   Have you presented this workshop before? ______

 
Type of Presentation:      Workshop ___ 
    

 
Desired Location:   Nassau/Levittown ____    Suffolk/Setauket ____   Other ______________
(other- please describe) __________________________________________________________
 
Room Set-Up for Presentation (i.e., # of tables, chairs and arrangements)
 ___________________________________________________________

 Applicant agrees to the guidelines for workshop
____________________ ________
                                                                                                                  Signature/date      

 


In addition to filling out the information on the above form, please attach an Outline of your Presentation. It is also recommended that Handouts be given to those attending your Workshop. These can be simple notes, diagrams or articles on the subject you are presenting.  Please submit these before the event as well. (They may be emailed as an Attachment to LIRC2@optonline.net )


Reiki Connection.org 
Offical web-site of the
Long Island Reiki Connection

Long Island Reiki Connection, P.O. Box 731, Babylon, NY 11702
Phone 1-877-547-3454


Any print or electronic reproduction is prohibited without expressed written permission.


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