{"id":6981,"date":"2018-03-08T16:22:46","date_gmt":"2018-03-08T21:22:46","guid":{"rendered":"https:\/\/rolandberard.com\/reiki-course-registration-form\/"},"modified":"2025-09-23T11:43:59","modified_gmt":"2025-09-23T16:43:59","slug":"reiki-course-registration-form","status":"publish","type":"page","link":"https:\/\/rolandberard.com\/en\/reiki-course-registration-form\/","title":{"rendered":"Reiki Course Registration Form"},"content":{"rendered":"<div>\n<p>Thank you for contacting me for a Reiki course.<\/p>\n<p>Please read the following information and then complete the<span style=\"text-decoration: underline;\"><em> <strong>FORM AT THE BOTTOM OF THIS PAGE<\/strong><\/em><\/span>\u00a0to register for a course.<\/p>\n<p>There will be a maximum of 12 students and perhaps some assistants. The course will be bilingual if necessary and course material is available in either French and English. You will receive a certificate once you have completed the course.<\/p>\n<\/div>\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">You may choose to follow the preparation for the course as suggested on my web site &#8211; <span style=\"color: #4787ff;\"><u class=\"\"><a class=\"\" href=\"https:\/\/rolandberard.com\/en\/courses-preparation-and-registration\/\">https:\/\/rolandberard.com\/cours-et-preparation\/<\/a><\/u><\/span><\/div>\n<\/div>\n<div>\u00a0<\/div>\n<div class=\"\">\n<h3>Level 1<\/h3>\n<p>In Reiki level 1, you learn about Reiki, its history, what it can be used for and also how to treat yourself and others and you will have a chance to practice. You also receive the 4 initiations that are part of the Reiki 1 level. These are a powerful catalyst for personal growth.<\/p>\n<p>There will be a maximum of 12 students and perhaps some assistants. The course will be bilingual if necessary and course material is available in either French and English. You will receive a certificate once you have completed the course. There are no prerequisites for taking Reiki.<br \/>If you are considering level 2, I suggest to wait 2-3 months for the 2nd level to allow some integration time.<\/p>\n<\/div>\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<div class=\"\">\n<h3>Level 2<\/h3>\n<p>In Reiki level 2, you learn the 3 symbols associated with that level, what they can be used for and also how to use them in an in-person treatment and a distance treatment and you will have a chance to practice. You will learn an alternative method of treatment. You also receive the 2 initiations that are part of the Reiki 1 level. These are a powerful catalyst for personal growth.<\/p>\n<p><strong>Cost<\/strong><\/p>\n<p>The cost of level 1 is $200<\/p>\n<p>The cost of level 2 is $250<\/p>\n<p><b>Deposit<\/b><\/p>\n<p>I require a $50 non-reimbursable deposit (check, Interac money transfer, Paypal or money order). For Interac and Paypal, For Interac and Paypal, please go to the Payment page of my website:<\/p>\n<p><a class=\"\" href=\"https:\/\/rolandberard.com\/en\/services-and-payment\/\">https:\/\/rolandberard.com\/services-et-paiement\/<\/a><\/p>\n<div class=\"\"><br class=\"\" \/>If paying by check or money order, please mail to:<\/div>\n<div class=\"\">Roland B\u00e9rard<\/div>\n<div class=\"\">\n<div class=\"\">5610 rue Viger<\/div>\n<div>St-Hubert, QC, J3Y 2Y5<\/div>\n<\/div>\n<div>\u00a0<\/div>\n<p><strong>My Reiki book at a reduced price<\/strong><\/p>\n<\/div>\n<div class=\"\">\n<div>I am offering my book \u201cReiki &#8211; A Powerful Catalyst for Personal Transformation and Healing\u201d to my students at a reduced price of:<\/div>\n<div><span style=\"text-decoration: underline;\">&#8211; paper version &#8211; $15 instead of the usual $25.<\/span><\/div>\n<div><span style=\"text-decoration: underline;\">&#8211; digital version &#8211; $5 instead of the usual $10.<\/span><\/div>\n<div>\u00a0<\/div>\n<\/div>\n<div class=\"\"><strong style=\"font-size: revert; color: initial; font-family: -apple-system, BlinkMacSystemFont, 'Segoe UI', Roboto, Oxygen-Sans, Ubuntu, Cantarell, 'Helvetica Neue', sans-serif;\">Course location<\/strong><\/div>\n<\/div>\n<div class=\"\">\n<div><br \/>You will receive an email to confirm the location before the class.<\/div>\n<div class=\"\">\u00a0<\/div>\n<div class=\"\"><br class=\"\" \/>Roland<\/div>\n<\/div>\n<div>\u00a0<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n\n<div class='fluentform ff-default fluentform_wrapper_19  ff_guten_block ff_guten_block-19 ffs_custom_wrap'><form data-form_id=\"19\" id=\"fluentform_19\" class=\"frm-fluent-form fluent_form_19 ff-el-form-top ff_form_instance_19_1 ff-form-loading ff_has_v3_recptcha ffs_custom\" data-form_instance=\"ff_form_instance_19_1\" method=\"POST\" data-recptcha_key=\"6LfpTZMqAAAAAEXwvzi3E63ImkpYVKaJAJMZjoLU\" ><fieldset  style=\"border: none!important;margin: 0!important;padding: 0!important;background-color: transparent!important;box-shadow: none!important;outline: none!important; min-inline-size: 100%;\">\n                    <legend class=\"ff_screen_reader_title\" style=\"display: block; margin: 0!important;padding: 0!important;height: 0!important;text-indent: -999999px;width: 0!important;overflow:hidden;\">Formulaire d&#8217;inscription au cours de Reiki (English)<\/legend><input type='hidden' name='__fluent_form_embded_post_id' value='6981' \/><input type=\"hidden\" id=\"_fluentform_19_fluentformnonce\" name=\"_fluentform_19_fluentformnonce\" value=\"5754a4b63d\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/en\/wp-json\/wp\/v2\/pages\/6981\" \/><div data-name=\"ff_cn_id_1\"  class='ff-t-container ff-column-container ff_columns_total_1 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 100%;'><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-19_1\" ><h3 class='ff-el-section-title'>Registration for the Reiki course<\/h3><div class='ff-section_break_desk'><\/div><hr \/><\/div><div data-type=\"name-element\" data-name=\"names_1\" class=\" ff-field_container ff-name-field-wrapper\" ><div class='ff-t-container'><div class='ff-t-cell '><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_19_names_1_first_name_' id='label_ff_19_names_1_first_name_' >First Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names_1[first_name]\" id=\"ff_19_names_1_first_name_\" class=\"ff-el-form-control\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell '><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_19_names_1_last_name_' id='label_ff_19_names_1_last_name_' >Last Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names_1[last_name]\" id=\"ff_19_names_1_last_name_\" class=\"ff-el-form-control\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_2\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group phone'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_19_phone_1' id='label_ff_19_phone_1' aria-label=\"Phone\">Phone<\/label><\/div><div class='ff-el-input--content'><input name=\"phone_1\" class=\"ff-el-form-control ff-el-phone ff_el_with_extended_validation\" type=\"tel\" data-name=\"phone_1\" id=\"ff_19_phone_1\" inputmode=\"tel\"  aria-invalid='false' aria-required=true><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_19_email_1' id='label_ff_19_email_1' aria-label=\"Email Adress\">Email Adress<\/label><\/div><div class='ff-el-input--content'><input type=\"email\" name=\"email_1\" id=\"ff_19_email_1\" class=\"ff-el-form-control\" data-name=\"email_1\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_3\"  class='ff-t-container ff-column-container ff_columns_total_1 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 100%;'><div class=\"ff-name-address-wrapper fluent-address\" data-type=\"address-element\" data-name=\"address_1\" ><div class='ff-el-input--content'><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_19_address_1_address_line_1_' id='label_ff_19_address_1_address_line_1_' aria-label=\"Address\">Address<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[address_line_1]\" id=\"ff_19_address_1_address_line_1_\" class=\"ff-el-form-control\" data-key_name=\"address_line_1\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_19_address_1_city_' id='label_ff_19_address_1_city_' aria-label=\"City\">City<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[city]\" id=\"ff_19_address_1_city_\" class=\"ff-el-form-control\" data-key_name=\"city\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_19_address_1_state_' id='label_ff_19_address_1_state_' aria-label=\"Province\/State\">Province\/State<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[state]\" id=\"ff_19_address_1_state_\" class=\"ff-el-form-control\" data-key_name=\"state\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_19_address_1_zip_' id='label_ff_19_address_1_zip_' aria-label=\"Postal Code\">Postal Code<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[zip]\" id=\"ff_19_address_1_zip_\" class=\"ff-el-form-control\" data-key_name=\"zip\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_19_address_1_country_' id='label_ff_19_address_1_country_' aria-label=\"Country\">Country<\/label><\/div><div class='ff-el-input--content'><select name=\"address_1[country]\" id=\"ff_19_address_1_country_\" class=\"ff-el-form-control\" placeholder=\"Country\" data-key_name=\"country\" aria-invalid='false' aria-required=true><option value=''>Country<\/option><option value='AF' >Afghanistan<\/option><option value='AX' >Aland Islands<\/option><option value='AL' >Albania<\/option><option value='DZ' >Algeria<\/option><option value='AS' >American Samoa<\/option><option value='AD' >Andorra<\/option><option value='AO' >Angola<\/option><option value='AI' >Anguilla<\/option><option value='AQ' >Antarctica<\/option><option value='AG' >Antigua and Barbuda<\/option><option value='AR' >Argentina<\/option><option value='AM' >Armenia<\/option><option value='AW' >Aruba<\/option><option value='AU' >Australia<\/option><option value='AT' >Austria<\/option><option value='AZ' >Azerbaijan<\/option><option value='BS' >Bahamas<\/option><option value='BH' >Bahrain<\/option><option value='BD' >Bangladesh<\/option><option value='BB' >Barbados<\/option><option value='BY' >Belarus<\/option><option value='BE' >Belgium<\/option><option value='BZ' >Belize<\/option><option value='BJ' >Benin<\/option><option value='BM' >Bermuda<\/option><option value='BT' >Bhutan<\/option><option value='BO' >Bolivia<\/option><option value='BQ' >Bonaire, Saint Eustatius and Saba<\/option><option value='BA' >Bosnia and Herzegovina<\/option><option value='BW' >Botswana<\/option><option value='BV' >Bouvet Island<\/option><option value='BR' >Brazil<\/option><option value='IO' >British Indian Ocean Territory<\/option><option value='VG' >British Virgin Islands<\/option><option value='BN' >Brunei<\/option><option value='BG' >Bulgaria<\/option><option value='BF' >Burkina Faso<\/option><option value='BI' >Burundi<\/option><option value='CV' >Cabo Verde<\/option><option value='KH' >Cambodia<\/option><option value='CM' >Cameroon<\/option><option value='CA' >Canada<\/option><option value='KY' >Cayman Islands<\/option><option value='CF' >Central African Republic<\/option><option value='TD' >Chad<\/option><option value='CL' >Chile<\/option><option value='CN' >China<\/option><option value='CX' >Christmas Island<\/option><option value='CC' >Cocos (Keeling) Islands<\/option><option value='CO' >Colombia<\/option><option value='KM' >Comoros<\/option><option value='CK' >Cook Islands<\/option><option value='CR' >Costa Rica<\/option><option value='HR' >Croatia<\/option><option value='CU' >Cuba<\/option><option value='CW' >Cura\u00e7ao<\/option><option value='CY' >Cyprus<\/option><option value='CZ' >Czech Republic<\/option><option value='CD' >Democratic Republic of the Congo (Kinshasa)<\/option><option value='DK' >Denmark<\/option><option value='DJ' >Djibouti<\/option><option value='DM' >Dominica<\/option><option value='DO' >Dominican Republic<\/option><option value='EC' >Ecuador<\/option><option value='EG' >Egypt<\/option><option value='SV' >El Salvador<\/option><option value='GQ' >Equatorial Guinea<\/option><option value='ER' >Eritrea<\/option><option value='EE' >Estonia<\/option><option value='SZ' >Eswatini<\/option><option value='ET' >Ethiopia<\/option><option value='FK' >Falkland Islands<\/option><option value='FO' >Faroe Islands<\/option><option value='FJ' >Fiji<\/option><option value='FI' >Finland<\/option><option value='FR' >France<\/option><option value='GF' >French Guiana<\/option><option value='PF' >French Polynesia<\/option><option value='TF' >French Southern Territories<\/option><option value='GA' >Gabon<\/option><option value='GM' >Gambia<\/option><option value='GE' >Georgia<\/option><option value='DE' >Germany<\/option><option value='GH' >Ghana<\/option><option value='GI' >Gibraltar<\/option><option value='GR' >Greece<\/option><option value='GL' >Greenland<\/option><option value='GD' >Grenada<\/option><option value='GP' >Guadeloupe<\/option><option value='GU' >Guam<\/option><option value='GT' >Guatemala<\/option><option value='GG' >Guernsey<\/option><option value='GN' >Guinea<\/option><option value='GW' >Guinea-Bissau<\/option><option value='GY' >Guyana<\/option><option value='HT' >Haiti<\/option><option value='HM' >Heard Island and McDonald Islands<\/option><option value='HN' >Honduras<\/option><option value='HK' >Hong Kong<\/option><option value='HU' >Hungary<\/option><option value='IS' >Iceland<\/option><option value='IN' >India<\/option><option value='ID' >Indonesia<\/option><option value='IR' >Iran<\/option><option value='IQ' >Iraq<\/option><option value='IE' >Ireland<\/option><option value='IM' >Isle of Man<\/option><option value='IL' >Israel<\/option><option value='IT' >Italy<\/option><option value='CI' >Ivory Coast<\/option><option value='JM' >Jamaica<\/option><option value='JP' >Japan<\/option><option value='JE' >Jersey<\/option><option value='JO' >Jordan<\/option><option value='KZ' >Kazakhstan<\/option><option value='KE' >Kenya<\/option><option value='KI' >Kiribati<\/option><option value='XK' >Kosovo<\/option><option value='KW' >Kuwait<\/option><option value='KG' >Kyrgyzstan<\/option><option value='LA' >Laos<\/option><option value='LV' >Latvia<\/option><option value='LB' >Lebanon<\/option><option value='LS' >Lesotho<\/option><option value='LR' >Liberia<\/option><option value='LY' >Libya<\/option><option value='LI' >Liechtenstein<\/option><option value='LT' >Lithuania<\/option><option value='LU' >Luxembourg<\/option><option value='MO' >Macao S.A.R., China<\/option><option value='MG' >Madagascar<\/option><option value='MW' >Malawi<\/option><option value='MY' >Malaysia<\/option><option value='MV' >Maldives<\/option><option value='ML' >Mali<\/option><option value='MT' >Malta<\/option><option value='MH' >Marshall Islands<\/option><option value='MQ' >Martinique<\/option><option value='MR' >Mauritania<\/option><option value='MU' >Mauritius<\/option><option value='YT' >Mayotte<\/option><option value='MX' >Mexico<\/option><option value='FM' >Micronesia<\/option><option value='MD' >Moldova<\/option><option value='MC' >Monaco<\/option><option value='MN' >Mongolia<\/option><option value='ME' >Montenegro<\/option><option value='MS' >Montserrat<\/option><option value='MA' >Morocco<\/option><option value='MZ' >Mozambique<\/option><option value='MM' >Myanmar<\/option><option value='NA' >Namibia<\/option><option value='NR' >Nauru<\/option><option value='NP' >Nepal<\/option><option value='NL' >Netherlands<\/option><option value='NC' >New Caledonia<\/option><option value='NZ' >New Zealand<\/option><option value='NI' >Nicaragua<\/option><option value='NE' >Niger<\/option><option value='NG' >Nigeria<\/option><option value='NU' >Niue<\/option><option value='NF' >Norfolk Island<\/option><option value='KP' >North Korea<\/option><option value='MK' >North Macedonia<\/option><option value='MP' >Northern Mariana Islands<\/option><option value='NO' >Norway<\/option><option value='OM' >Oman<\/option><option value='PK' >Pakistan<\/option><option value='PW' >Palau<\/option><option value='PS' >Palestinian Territory<\/option><option value='PA' >Panama<\/option><option value='PG' >Papua New Guinea<\/option><option value='PY' >Paraguay<\/option><option value='PE' >Peru<\/option><option value='PH' >Philippines<\/option><option value='PN' >Pitcairn<\/option><option value='PL' >Poland<\/option><option value='PT' >Portugal<\/option><option value='PR' >Puerto Rico<\/option><option value='QA' >Qatar<\/option><option value='CG' >Republic of the Congo (Brazzaville)<\/option><option value='RO' >Romania<\/option><option value='RU' >Russia<\/option><option value='RW' >Rwanda<\/option><option value='RE' >R\u00e9union<\/option><option value='BL' >Saint Barth\u00e9lemy<\/option><option value='SH' >Saint Helena<\/option><option value='KN' >Saint Kitts and Nevis<\/option><option value='LC' >Saint Lucia<\/option><option value='SX' >Saint Martin (Dutch part)<\/option><option value='MF' >Saint Martin (French part)<\/option><option value='PM' >Saint Pierre and Miquelon<\/option><option value='VC' >Saint Vincent and the Grenadines<\/option><option value='WS' >Samoa<\/option><option value='SM' >San Marino<\/option><option value='ST' >Sao Tome and Principe<\/option><option value='SA' >Saudi Arabia<\/option><option value='SN' >Senegal<\/option><option value='RS' >Serbia<\/option><option value='SC' >Seychelles<\/option><option value='SL' >Sierra Leone<\/option><option value='SG' >Singapore<\/option><option value='SK' >Slovakia<\/option><option value='SI' >Slovenia<\/option><option value='SB' >Solomon Islands<\/option><option value='SO' >Somalia<\/option><option value='ZA' >South Africa<\/option><option value='GS' >South Georgia\/Sandwich Islands<\/option><option value='KR' >South Korea<\/option><option value='SS' >South Sudan<\/option><option value='ES' >Spain<\/option><option value='LK' >Sri Lanka<\/option><option value='SD' >Sudan<\/option><option value='SR' >Suriname<\/option><option value='SJ' >Svalbard and Jan Mayen<\/option><option value='SE' >Sweden<\/option><option value='CH' >Switzerland<\/option><option value='SY' >Syria<\/option><option value='TW' >Taiwan<\/option><option value='TJ' >Tajikistan<\/option><option value='TZ' >Tanzania<\/option><option value='TH' >Thailand<\/option><option value='TL' >Timor-Leste<\/option><option value='TG' >Togo<\/option><option value='TK' >Tokelau<\/option><option value='TO' >Tonga<\/option><option value='TT' >Trinidad and Tobago<\/option><option value='TN' >Tunisia<\/option><option value='TM' >Turkmenistan<\/option><option value='TC' >Turks and Caicos Islands<\/option><option value='TV' >Tuvalu<\/option><option value='TR' >T\u00fcrkiye<\/option><option value='UG' >Uganda<\/option><option value='UA' >Ukraine<\/option><option value='AE' >United Arab Emirates<\/option><option value='GB' >United Kingdom (UK)<\/option><option value='US' >United States (US)<\/option><option value='UM' >United States (US) Minor Outlying Islands<\/option><option value='VI' >United States (US) Virgin Islands<\/option><option value='UY' >Uruguay<\/option><option value='UZ' >Uzbekistan<\/option><option value='VU' >Vanuatu<\/option><option value='VA' >Vatican<\/option><option value='VE' >Venezuela<\/option><option value='VN' >Vietnam<\/option><option value='WF' >Wallis and Futuna<\/option><option value='EH' >Western Sahara<\/option><option value='YE' >Yemen<\/option><option value='ZM' >Zambia<\/option><option value='ZW' >Zimbabwe<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_4\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 49.95%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_19_input_text_4' id='label_ff_19_input_text_4' aria-label=\"Desired course level\">Desired course level<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_4\" class=\"ff-el-form-control\" data-name=\"input_text_4\" id=\"ff_19_input_text_4\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Languages Spoken\">Languages Spoken<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_3_e6509ef55f66ac9eda3144156dc7e561'><input  type=\"checkbox\" name=\"checkbox_3[]\" data-name=\"checkbox_3\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"English\"  id='checkbox_3_e6509ef55f66ac9eda3144156dc7e561' aria-label='English' aria-invalid='false' aria-required=true> <span>English<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_3_e1f9b46942504c9193bbe7f1c4290b49'><input  type=\"checkbox\" name=\"checkbox_3[]\" data-name=\"checkbox_3\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"French\"  id='checkbox_3_e1f9b46942504c9193bbe7f1c4290b49' aria-label='French' aria-invalid='false' aria-required=true> <span>French<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_3_adac1b0bb6117ebc299c1c7f7c6d65fd'><input  type=\"checkbox\" name=\"checkbox_3[]\" data-name=\"checkbox_3\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Other\"  id='checkbox_3_adac1b0bb6117ebc299c1c7f7c6d65fd' aria-label='Other' aria-invalid='false' aria-required=true> <span>Other<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Gender\">Gender<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_4_2eeea9942713b2600ed22ccd74564d51'><input  type=\"checkbox\" name=\"checkbox_4[]\" data-name=\"checkbox_4\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Male\"  id='checkbox_4_2eeea9942713b2600ed22ccd74564d51' aria-label='Male' aria-invalid='false' aria-required=true> <span>Male<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_4_08f96074b3818164aa95abaf4500ef6a'><input  type=\"checkbox\" name=\"checkbox_4[]\" data-name=\"checkbox_4\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Female\"  id='checkbox_4_08f96074b3818164aa95abaf4500ef6a' aria-label='Female' aria-invalid='false' aria-required=true> <span>Female<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_19_input_text_5' id='label_ff_19_input_text_5' aria-label=\"Name on certificate\">Name on certificate<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_5\" class=\"ff-el-form-control\" data-name=\"input_text_5\" id=\"ff_19_input_text_5\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Deposit - following confirmation of an available place\">Deposit &#8211; following confirmation of an available place<\/label><div class=\"ff-el-tooltip\" data-content=\"A non-refundable deposit of $50 is required to hold your spot.\"><svg width=\"16\" height=\"16\" viewBox=\"0 0 25 25\"><path d=\"m329 393l0-46c0-2-1-4-2-6-2-2-4-3-7-3l-27 0 0-146c0-3-1-5-3-7-2-1-4-2-7-2l-91 0c-3 0-5 1-7 2-1 2-2 4-2 7l0 46c0 2 1 5 2 6 2 2 4 3 7 3l27 0 0 91-27 0c-3 0-5 1-7 3-1 2-2 4-2 6l0 46c0 3 1 5 2 7 2 1 4 2 7 2l128 0c3 0 5-1 7-2 1-2 2-4 2-7z m-36-256l0-46c0-2-1-4-3-6-2-2-4-3-7-3l-54 0c-3 0-5 1-7 3-2 2-3 4-3 6l0 46c0 3 1 5 3 7 2 1 4 2 7 2l54 0c3 0 5-1 7-2 2-2 3-4 3-7z m182 119c0 40-9 77-29 110-20 34-46 60-80 80-33 20-70 29-110 29-40 0-77-9-110-29-34-20-60-46-80-80-20-33-29-70-29-110 0-40 9-77 29-110 20-34 46-60 80-80 33-20 70-29 110-29 40 0 77 9 110 29 34 20 60 46 80 80 20 33 29 70 29 110z\" transform=\"scale(0.046875 0.046875)\"><\/path><\/svg><\/div><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2_adfff46ae752e658b2874227608d7bdb'><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Interac transfer - roland@rolandberard.com\"  id='checkbox_2_adfff46ae752e658b2874227608d7bdb' aria-label='Interac transfer - roland@rolandberard.com' aria-invalid='false' aria-required=true> <span>Interac transfer &#8211; roland@rolandberard.com<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2_2f424277eb0552ebbbe98f07f0179129'><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Credit card with Paypal - copy and paste this link into your browser https:\/\/rolandberard.com\/fr\/services-et-paiement\/#reikicourses\"  id='checkbox_2_2f424277eb0552ebbbe98f07f0179129' aria-label='Credit card with Paypal - copy and paste this link into your browser https:\/\/rolandberard.com\/fr\/services-et-paiement\/#reikicourses' aria-invalid='false' aria-required=true> <span>Credit card with Paypal &#8211; copy and paste this link into your browser https:\/\/rolandberard.com\/fr\/services-et-paiement\/#reikicourses<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2_a9923796564150f576c2aa3f819da90a'><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Check\"  id='checkbox_2_a9923796564150f576c2aa3f819da90a' aria-label='Check' aria-invalid='false' aria-required=true> <span>Check<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group  ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Would you like to subscribe to my mailing list?\">Would you like to subscribe to my mailing list?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_3_3a1f7db5a709209beff92ea935cd6932'><input  type=\"radio\" name=\"input_radio_3\" data-name=\"input_radio_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Yes\"  id='input_radio_3_3a1f7db5a709209beff92ea935cd6932' aria-label='Yes' aria-invalid='false' aria-required=true> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_3_2a95d110852612b415a0f718d5d00033'><input  type=\"radio\" name=\"input_radio_3\" data-name=\"input_radio_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"No\"  id='input_radio_3_2a95d110852612b415a0f718d5d00033' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50.05%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_19_input_text_6' id='label_ff_19_input_text_6' aria-label=\"Please indicate the date of the desired course\">Please indicate the date of the desired course<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_6\" class=\"ff-el-form-control\" data-name=\"input_text_6\" id=\"ff_19_input_text_6\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group  ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Certificate language\">Certificate language<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_411ce9aa2090108c2e9a5fe616c56668'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"French\"  id='checkbox_411ce9aa2090108c2e9a5fe616c56668' aria-label='French' aria-invalid='false' aria-required=true> <span>French<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_b8c7aca77f742947cb530de82c5ae2fb'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"English\"  id='checkbox_b8c7aca77f742947cb530de82c5ae2fb' aria-label='English' aria-invalid='false' aria-required=true> <span>English<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group  ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Manual language\">Manual language<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_9d72c596a22f9460666f4e002aa02364'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"French\"  id='checkbox_1_9d72c596a22f9460666f4e002aa02364' aria-label='French' aria-invalid='false' aria-required=true> <span>French<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_d2d869097dfbe7b7478281fff8a40083'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"English\"  id='checkbox_1_d2d869097dfbe7b7478281fff8a40083' aria-label='English' aria-invalid='false' aria-required=true> <span>English<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group  ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Reserve me a printed book for $15\">Reserve me a printed book for $15<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_1_49648cf67a1ed2490ad6a20ccf73271c'><input  type=\"radio\" name=\"input_radio_1\" data-name=\"input_radio_1\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Yes\"  id='input_radio_1_49648cf67a1ed2490ad6a20ccf73271c' aria-label='Yes' aria-invalid='false' aria-required=true> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check 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Please read the following information and then complete the FORM AT THE BOTTOM OF THIS PAGE\u00a0to register for a course. There will be a maximum of 12 students and perhaps some assistants. 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