Oneness Awakening Course Application

Applicants Name
Street Address
City
State
Zip Code
Home phone
Cell phone
Email address
Course Dates:
Course Location:
Course Fee (please check):
____$195 (paid by May 14th) ___$215 (paid after May 14th)
____$125 (Oneness Blessings Givers only)
____Free to Oneness Blessing Givers who bring someone new ___________________
(name)
Please make checks payable to: Rujing Wang
Unless paying electronically, please mail payments to:
Rujing Wang
37 Robin Hood Rd
Arlington MA 02474
1. Have you received the Oneness Blessing? _____
2. How did you hear about this course?
3. Are you currently using or have you used within the last 6 months any medicat
ions for any mental health problem? _________
4. Have you ever been institutionalized for a mental health problem? __________
_____
5. Have you ever been diagnosed with a mental health problem? ______________
If so, please describe the problem?
6. Are you challenged by substance dependence or abuse? If so, which substances
and how regularly do you use them?
I hereby state that all of my answers to the questions contained in this applica
tion are true, correct and complete.
__________________________________
Applicants Signature
Please email this form to rujing.oneness@gmail.com (send as attachment).
Or print out and mail it along with your payment. Thank you!