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The Great Embrace: Ceremony Request Form

Welcome. Your responses will be received with care, held in trust, and honoured in confidentiality.
Let this space be a gentle pause, an invitation to soften, reflect, and speak from your heart.
If you have any questions about the form or would like to connect before moving forward, let me know via email.

“What you are looking for, is what is looking.” — Rupert Spira

SECTION 1: Who You Are


“Your own Self-Realization is the greatest service you can render the world.” — Ramana Maharshi

Full Name

Birthday (DD/MM/YY)

Optional: birth time and location for a Birth Chart and Gene Key reading

Email Address

Phone Number

Location

Preferred Pronouns

Emergency Contact (Name & Phone Number)

In the unlikely event of an emergency, please share someone trusted that I can connect with.