Member Application |
The Reiki Alliance
34 Rural Rd. PO Box 451
Belchertown, MA 01007 USA
Telephone: 1 413 323-4381
NOTE: this form is meant only for new applicants to the Reiki Alliance, it is NOT for setting up an online website account for current members.
membership@reikialliance.com
applications@reikialliance.com
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* First Name
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* Last Name
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Last Name Prefix
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* Address
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Address - Line Two (Apt/Suite)
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* City
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State/Province
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* Postal/Zip Code
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* Country
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* Telephone
Please use this format: Country/Area code - City Code - Number
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Fax
Please use this format: Country/Area code - City Code - Number
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Mobile
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* First Degree - Initiated by
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* First Degree - Date
Month, Year
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* Second Degree - Initiated by
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* Second Degree - Date
Month, Year
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* Date you became a master candidate
Month, Year
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* Master Initiation - Initiated by
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* Date made Master
MM, YY
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* Address and telephone of initiating master
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* Lineage 4
Fill in each line starting with the master who initiated you as a master until you reach a member of the Spiritual lineage: Miako Usui, Chujiro Hayashi, Hawayo Takata or Phyllis Furumoto.
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Lineage 5
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Lineage 6
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Lineage 7
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Lineage 8
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Lineage 9
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Lineage 10
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Lineage 11
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Lineage 12
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Lineage 13
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Lineage 14
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Lineage 15
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* Largest City Near You
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* Newsletter Language
Please specify the language you would like to receive your newsletter
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* Blue Book Language
Please specify the language you would like to receive your blue book
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* What languages do you speak?
As a comma separated list, please
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Future Website Account Information
Please choose a username and password you would like to use once the application has been reviewed and your membership activated.
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* Username Usernames must be at least 4 characters long |
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* Password Passwords must be at least 5 characters long |
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* Confirm Password |
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* Screen Name
If you leave this field blank, your screen name will be the same as your username
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* Email Address |
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* Confirm Email Address |
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* Submit the word you see below:
* Indicates required fields
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