Customer Registration Form

Dear Customer, Thank you for investing in your health and energy! If you register your Egyptian Healing Rods purchase within 14 days we will offer you a free ticket to one of our advanced Tele-classes to have an interactive learning experience. (see tele-class schedule) This offer is limited, one per customer address... Register Today!

Please provide the following contact information:

Name:
Street Adress:
Address (cont.) :
City :
State/Province:
Zip/Postal Code:
Country:
E-mail:
Where did you purchase your Egyptian Healing Rods?
	Expo or Demonstration Event:
	Private consultation with Dealer/Practioner:
Name of the Reseller:
Serial Number of your Rods (printed on your Certificate of Authenticity):
If you purchased additional sets of Rods, list their certificate numbers here:

Customer Registration Form

Please provide the following contact information:

Where did you purchase your Egyptian Healing Rods?

Name of the Reseller:

Serial Number of your Rods

If you purchased additional sets of Rods, list their certificate numbers here: