Healing Sanctuary Information register success – Carol Everett Healing Sanctuary

Register success!

Thank you for subscribing to the Healing sanctuary. Please complete the information below. Also please note that to submit this form we require you to upload a recent clear photo of yourself. (preferred is head & shoulders or waist up, or ‘selfie’. ) If you don’t have this to hand right now to complete do not worry! A link to this page will be contained within your welcome email, ( be sure to check your junk ) you can come back and complete this part later.

WHO is included in your subscription, Yourself or Someone else, pet, situation etc? *

Allows registering other people under your data. BUT You remain primary subscriber.

Name (Primary Subscriber) *

First

Last

Date of Birth, primary subscriber : dd/mm/yyyy *

Email (Primary Subscriber) *

Confirm Email

email of person responsible for maintaining membership

Your main areas of concern for healing focus while included in The Healing Sanctuary, (Just a Short description) CLEARLY SEPARATE OTHER NAME if appilicable. *

1st Main Subscriber name… Areas of concern. (NEW LINE) 2nd Secondary Subscriber name… Areas of concern

Please upload a recent photo of yourself, (Primary member or other)

Click or drag files to this area to upload. You can upload up to 2 files.

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