This form should be completed by all human members included in the family or group registering for annual Earth Heal membership. All info that is shared is is treated with complete confidentiality.
Q1 - Q4 require an answer, but feel free to include as much or as little info as you like for Q5 - Q9.
Send the completed form by clicking the 'Done' button at the bottom of the page when you have finished, or if you prefer to send it via e-mail, just copy and paste the form (without clicking the "Done" button) into the body of an e-mail and send it to: earthhealadmin[at]gmail[dot]com
Please send us a head and shoulders pic, with your eyes showing, to: earthhealadmin[at]gmail[dot]com
Thank you for registering as an Earth Heal member. We will soon be in touch with you via e-mail.