Registration Form | ROSE ALCHEMY HEALING

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Please fill out the following form to attend an event or appointment with

Angela Jeanne Rose Heart - Rose Alchemy Healing.

First Name

Email Address

Last Name

Phone/Text

What event are you Registering for?

Elemental - Kundalini Yoga Class

8/8 Lions Gate - Sunday, August 8th 9-11pm

Sedona Labyrinth Experience

Chakra Clearing, Drum Journey, Gong Bath

Sound Bath, Meditation & Mindfulness

1-on-1 Spiritual Awakening Support

Reiki Session

Reiki & Sound Healing Session

Plant Medicine Journey

Inner Alchemy Activation

Reiki Training Certification

Private Session

If there are other people joining you, please list their names.

Why are you drawn to this activity/ experience? What is your intention?

Do you have any medical or physical concerns?

Have you been exposed to COVID-19?

Do you have any symptoms of being sick ie: cough, fever?

Do you have a question or concern to ask before the event/appointment?

Initials

I declare that the info I’ve provided is accurate & complete

Enter the amount you wish to pay:

Thanks for submitting!

You can also pay via:

Contact Angela:

(808) 741-1559

*Please be sure you want to attend or receive before purchasing.

*While things do happen, there are NO refunds on Groups, Couples, Deposits, Courses, or Sessions.

You can however use your payment/deposit to reschedule.