Form - Spiritual Well-Being

*Shamanic Spiritual Well-Being Program*
Please fill out this form in full.

To participate at the level of your choosing, please fill out, in full, this *Shamanic Spiritual Well-Being Program* application form.

Attention ~	$111 per season. $416 if paid one year in advance, a savings of $28.
Intention ~	$222 per season, two seasons minimum. $777 if paid one year in advance, a savings of $111.
Manifestation ~	$333 per season, four seasons (one full year) minimum. $1,111 if paid one year in advance, a savings of $221.

I am choosing to participate in this level of the Shamanic Spiritual Well-Being Program:

	Attention (by season or by the year)
	Intention (minimum of two consecutive seasons required)
	Manifestation (minimum of four consecutive seasons – one full year – required)

I am choosing to participate in the following seasons of the Shamanic Spiritual Well-Being Program:

	Autumn Winter Spring Summer

Name:
Email:
City/State:

Date of Birth:
Time of Birth:
Birth Place:

Comments:

By signing and submitting this form you are agreeing to the terms of this agreement, and to participate in and receive the full measure of services offered by Jade Wah'oo Grigori pursuant to the level you have signed up and paid for. To review the offerings, click here. All payments must be made prior to the initiation of services rendered. While Jade Wah'oo Grigori offers the opportunity of seasonal payments for your convenience, your electronic signature is your binding agreement to complete payment for all services you have signed up for, regardless of whether or not you actively engage the remainder of services contracted. No refunds are offered, unless Jade Wah'oo Grigori cancels the Shamanic Spiritual Well-Being Program.

Signed:
Date:

After Registering by Submitting the above form you will be directed to the Purchase Page to send your Online Payment or Deposit using PayPal or a Major Credit Card.

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