You are registering for Introduction to Energy Medicine

REGISTRATION

Name

Phone Number

Address

September 18, 2021 9am -5pm

Convenience Fee of 3% will be added when using Credit Card through this registration form. To avoid convenience fee, select pay offline.

When selecting Pay Offline vs. the Credit Option in the Billing Payment Section below, the convenience fee will be waived.

Options for paying offline should be completed within 72 hours of registration and can be done through Zelle, Venmo or check.

To pay by Venmo or Zelle, use [email protected] or cell phone 630-301-8331.

To pay by check offline, make checks payable to Kelly Goetz and mail to 1528 Lantern Circle, Naperville, IL 60540

Convenience Fee

$0.00

PRE-CLASS SURVEY

Profession

Where did you first learn about this class?

Other: Type Here

What experience do you have with Energy Work? (No Experience Required)

Are you currently a Eden Method Practitioner?

Would you like to learn more about Level 1 Fundamentals?

TERMS AND CONDITIONS

Important Class Details

Class will meet in-person and follow CDC guidelines. Students will need to have a mask and plan to wear them to support the class at large if necessary.

In-person classes will receive handouts at class.

Class location:
Kelly's home office:
1528 Lantern Circle
Naperville, IL 60540

All students must register independently. Sharing the experience with a friend or family member is always an excellent idea.

I have read and agree to the terms above.

Missed Class/Withdrawal Policy

Full Refunds will be provided if cancellation has been made in writing 14 days in advance. Please notify us by September 4, 2021 if your plans change.

Cancellation within September 3rd -September 14th will receive a 50% refund.

Cancellations after September 15, 2021 or 72 hours prior to class are non refundable. We will do our best to get you into another class if available.

In the event that class is cancelled by Kelly Goetz, Healing Bridge due to low enrollment, your full tuition will be refunded or you will be given the option to apply it to the another class.

I have read and agree to the terms above.

Release Agreement

The practices shared by Kelly Goetz are not meant to replace care provided by licensed medical professionals.

By referring to Kelly Goetz/Healing Bridge and Innersource classes, you release all liability from Kelly Goetz/ Healing Bridge, Innersource and related parties such The Eden Method.

I, the undersigned, agree to the terms above.

Billing Information

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