Fill out all parts of order form. Enclose a picture of you (full body). The photo can be xeroxed. Photo will not be returned.

On a seperate piece of paper:

1. Tell me about yourself.
2. Describe why you want a Reiki session.
3. Make the explianation long enough so that I can gain a connection with you.

Please Print Clearly:

Name: _____________________________________

Address: ___________________________________

__________________________________________

Phone: (____)________________________

Email: _______________________________

Date of Class: ___________________


Place a checkmark next to your selection below:

_____$30.00 - One Session

_____$55.00 - Two Session

Make checks and money orders payable to: Connie Tsouras

Mail to:

Ashkee's Earth Medicine
10514 Lark Ridge
Houston, TX 77070