Fast Track Healing - Payment Form

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Name (Last, First):
D.O.B: (mm/dd/yyyy)
Address:
City / State / Zip:
Primary email:
Primary phone:
Referred by:

Intention:
Be specific on what you want and why.

For Astral Session, please
provide a photo URL*:

*Photo URL is a web link where your photo can be seen and downloaded from (Facebook Homepage, etc.) If your photo is not available online, email a small JPEG to , subject line, "Photo for Fast Track."
Photos, though not absolutely necessary, help focus the energy on the right people.
Options Regular Rates Introductory Rates Choose this option

Morning Astral Sessions (2x/wk)
Tues + Thurs
8am–9am PT
May 29 through June 28
(no session June 21)
9 one-hour sessions over 5 weeks
Maximum Attendees: 12

$200

$99
(50% off; just over $12 per session)
Includes One Session for Free!

Morning Astral Sessions (3x/wk)
Mon + Wed + Fri
8am–9am PT
May 28 through June 29
(no sessions June 20 or June 22)
13 one-hour sessions over 5 weeks
Maximum Attendees: 12

$300

$149
(50% off; just over $12 per session)
Includes One Session for Free!

Evening Astral Sessions (2x/wk)
Tues + Thurs
6pm–7pm PT
May 29 through June 28
(no session June 21)
9 one-hour sessions over 5 weeks
Maximum Attendees: 12

$200

$99
(50% off; just over $12 per session)
Includes One Session for Free!

Evening Astral Sessions (3x/wk)
Mon + Wed + Fri
6pm–7pm PT
May 28 through June 29
(no sessions June 20 or June 22)
13 one-hour sessions over 5 weeks
Maximum Attendees: 12

$300

$149
(50% off; just over $12 per session)
Includes One Session for Free!

Morning Phone Sessions (2x/wk)
Tues + Thurs
9am–10am PT
May 15 through June 7
8 one-hour sessions over 4 weeks
Maximum Attendees: 6
$300 $149
(50% off; $18.63 per session)
Enrollment
Closed
Typed Signature:
Date: 05/17/2012
(submit on next page)

Disclaimer:
Sessions are not intended to diagnose, cure, prevent, or treat your symptoms, disease, illness, or alike, or to diagnose or replace your medical treatment in any way. Dave Markowitz, and affiliates thereof make no medical claims whatsoever and assume no liability of any kind for the (mis)interpretation or (mis)implementation of the content of your session, either spoken or implied. Simply use what resonates with you and discard the rest. Remember, it's always best to see (and hug) your Doctor.

Dave Markowitz reserves the right to decline services to anyone who he deems as an inappropriate match for his gifts; if that should occur, a refund will be returned for prepaid and unused sessions.

Above Photo ©Amanda Daniels. Used with permission.
Unauthorized reproduction is prohibited.

Healing with Source symbol used with permission from Janet Cristenfeld