Enrollment Form

Name as It Will Appear on Your Certificate

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Please enter your full name exactly as you would like it to appear on your official Reiki Certificate.

Carefully check the spelling, capitalization, and order of your name before submitting.

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Example:
Dr. Jane Marie Smith
Jane M. Smith
Jane Smith

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Your certificate will be prepared using the name you provide. Please do not enter nicknames, initials, or professional titles unless you would like them printed on your certificate.

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Certificate Name:

Please write your name exactly as you would like it to appear on your certificate.