Register for the next Quantum-Touch Workshop!

HeartMind Energies

Quantum-Touch Healing

Inner Relationship Focusing

How Do I Register for a Quantum-Touch Basic Workshop?

Step 1: Complete the Registration form below.

Once you have completed the Registration form, click "Submit."

Step 2: Pay for the Workshop.

Once you have submitted your Registration form, you will receive a confirmation page with a link to the Online Payment page. There, you can pay online via credit card or PayPal.

I am also providing a link here for the Online Payment page in case you wish to return to it later on.

If you would prefer to pay with a check, please send it to the following address:

Jocelyn Jacks Kahn
HeartMind Energies
808 High Mountain Road
Franklin Lakes, NJ 07417

Quantum-Touch Basic Workshop Registration Form

Please note that all fields followed by an asterisk must be filled in.

Workshop You Wish to Attend:*
Workshop You Wish to Attend:*

Name (as you would like it on your Certificate of Completion)*
Name (as you would like it on your Certificate of Completion)*

E-mail Address*
E-mail Address*

Street Address*
Street Address*

City*
City*

State/Prov*
State/Prov*

Zip/Postal Code*
Zip/Postal Code*

Home Phone*
Home Phone*

Business Phone*
Business Phone*

Cell Phone*
Cell Phone*

Have you taken a previous QT Live (NOT Video) Basic Workshop *
Have you taken a previous QT Live (NOT Video) Basic Workshop *

	No
	Yes (Copy of previous Certificate of Completion required)

Form of Payment*
Form of Payment*

	I am paying online
	I am paying with a check

How did you find us?

Please enter the word that you see below.

IMPORTANT: We will register you provisionally for three days once we receive your registration form. If we have not received your payment by then, you will be moved to our waiting list until we receive your check. We appreciate your prompt payment!