FOR OUR FILES:

Name:                   

Mailing/Street Address: 

Town:                    

County/State:     

Postal Code:        

Country:               

Telephone number (home):  

Telephone number (work):  

Telephone number (mobile):  

Email address : 

Please do not send me any group emails (Cyber Journals) 

Please do not send me any paper copies of the Journal of Energy Therapy (in the mail)   

Please do not keep me on the "Earth Angels" list 

FOR THE WEBSITE LISTING ("FIND AN INSTRUCTOR" PAGE):

Name:                   

Town:                    

County/State:     

Country:               

Telephone number (you can only list one on the website - so pick the one to list):  

Email address : 

Website : 

I would prefer not to be listed (at all) on the website