Reiki TUMMO Distant Learning Student Data
(for alumni data and certificate)
(Please complete this form and then email back to us along with your paypal payment receipt. You can copy and paste this data into your email instead of using email attachment. Your personal information will be kept confidential. However, you may leave some lines blank if you wish).

1. First name: .......................................................................     2. Midle name: ...........................................................................
3. Last name: .......................................................................     4. Gender: ......................................................(Male or Female)
5. Place and Date of Birth: ............................................................................................................................................................
6. Name and title you wish it to appear on your certificate: .......................................................................................................
7. Home Address: ...........................................................................................................................................................................
8. Complete Postal or Mailing address to send the certificate (include: City, Province, State, Country and Postal Code or PO Box Number):
..........................................................................................................................................................................................................
9. E-mail Address: ................................................................    10. Web Site Address (if any): ...................................................
11. Skype ID (for online guidance/exercise): .................................................................................................................................. 
12. Home Phone number <country code> + <area code> + <Phone number>: ...........................................................................
13. Mobile Phone number <country code> + <area code> + <Phone number>: .........................................................................
14. Fax Number  <country code> + <area code> + <Phone number>: .........................................................................................

15. Distant Learning Package: (please choose one and delete the rest):        1            or              2          or          1 & 2
16. Amount of Payment: US$.........................................         17. Payment method: ........................ (e.g. PayPal or via friend)
18. Date of Payment: ......................................................................................................................................................................   
19. Your Local Time Setting Name (e.g. PDT, EST): ..................................................................................................................
20. Your Local Time Difference to GMT Time (e.g. GMT – 12 hours, GMT + 7 hours ):  .......................................................
(please visit http://www.timeanddate.com/ for guidance)
21. Proposed Distant Attunement Schedule for Each Level  (day, date and your local time):  
Level 1: ………………………………………………………………………………………………..……....................
Level 2: ………………………………………………………...........................(at least 1 day after Level 1 attunement)
22. Proposed your available time for Skype online guidance/exercise (1-2 hours time):
..........................................................................................................................................................................................................

NOTE:
a) The 2nd level attunement should be done at least one day after receiving the 1st level attunement. Please propose your most convenient schedule and you need at least 1 hour quality time for each level of attunement (15 minutes attunement + 45 minutes self healing practice right away after the attunement). Do not worry about our local time difference. We can easily adapt to your proposed schedule. 
b) If you are in USA, Canada, Europe or New Zealand, please email this data along with your PayPal payment receipt to reikitummo@gmail.com and please add the Skype ID of paramajaya to your Skype contact list. If you are in Asia or South America or other country please email to tettyj@gmail.com and add the Skype ID of tetty05 to you Skype contact list. 

c) If you have a facebook account, before or after the attunement, you are welcome to join our facebook discussion groups: https://www.facebook.com/groups/Kundalini.Reiki.Tummo/ for discussion in English or https://www.facebook.com/groups/Reiki.Kundalini.Bukahati/ if you understand Indonesian. We have active sharing and discussions amongst our alumni all over the world. Please add also the facebook account of Reiki Tummo as your facebook friend to ease the subscription to those facebook groups.