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Brilliant Greetings
This is the passenger information form and filling it out is not the same as registering. Please fill out this information so we can serve you to the best of our ability. We will then respond. Thank you so much!
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1
Do you understand that you are submitting information in general and that you are not registering for a ceremony?
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Name
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First Name
Last Name
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Email
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example@example.com
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Phone Number
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Area Code
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Male/Female
Female
Male
Female
Male
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Height
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Weight
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Age
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Current Home City & State
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Profession
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Smile Quick and Take a Selfie
Cheeeeeze
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12
Emergency Contact Person and their Phone number
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13
What are your interests and intentions in attending the meditation? What are the things in your life that you seek to change, improve or reinforce?
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14
Do you have prior experience with this type of meditation? Please briefly explain how long you have participated in the meditations and any outcomes you have had.
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15
If you have not had experience with this meditation, have you had any other type of mind-expanding experience?
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16
Please inform us of any medical conditions you have had in the past and any medical conditions you are currently dealing with (diagnosed or undiagnosed).
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17
Please list any medications/drugs, natural medicines or supplements, and vitamins that you are presently taking. If you will need to take any of these during the time of the meditation, please inform us which ones.
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18
Covid
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Due to the wide variety of conflicting medical information concerning Covid and the 2 part experimental injections affecting different folks differently, we feel a responsibility to be looking to see if there is any difference between ceremony results for those choosing to get the shots and those who do not. Please say either Yes or No below if you have been vaccinated. After that, feel free to mention any thoughts you may have on the subject.
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19
Have you ever been hospitalized or treated for any kind of mental illness or disorder including depression, bipolar disorder, schizophrenia, or other condition? If so, please explain below.
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20
Have you ever suffered a seizure, if so please explain below.
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21
Do you feel physically, emotionally, and psychologically prepared to experience this type of meditation?
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22
What are three things you LOVE in this world and why?
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23
Anything else? Questions? Things we should know?
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24
Are you interested in one or both nights?
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25
What Ceremony dates were you interested in?
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26
How did you hear about us or who connected you with us?
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Image Field
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