Fast Track Healing - Payment Form

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Name (Last, First):
D.O.B:	(mm/dd/yyyy)
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City / State / Zip:	Select AL AK AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA ME MD MI MO MN MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
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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