Name *

First Name

Last Name

Phone *

(###)

###

####

How many people are you looking to facilitate? *

Sm Group (2-12)

Med group (13-25)

lg group (26 +)

individual sessions

Preferred Date

MM

DD

YYYY

What type of meditation are you interested in? *

stress / anxiety

presence / awareness

emotional intelligence

pain management

leadership / confidence

family / kids / relationships

consciousness / higher-self / wisdom

healing / trauma / addiction