Individual or Group Blessing Information Form

Thank you for choosing Michèle to provide you with a special Blessing.

As a reminder: Group Blessings are on the Sunday early dawn following the receipt of this questionnaire. (If received by Friday midnight). If not then it will go to the following Sunday. For Individual Blessings, you will be notified by email of the date and time of the Blessing.

For GENERAL BLESSINGS, Michèle blesses by the group. Your name is added to a list that she blesses.

For INDIVIDUAL BLESSING Michèle blesses each individual separately which at times can be directed to more specific results and powerful RESULTS.

Blessings Request Individual & Group

Name(Required)

First Last

Email(Required)

Phone(Required)

I Am Booking a Blessing for:(Required)

Myself

A Family Member

A Friend

A Baby Or Child

Other

Please select one:

Date of Birth; if known(Required)

If you do not know the birthday, please use today's date.

The Name of Person You Wish To Have A Blessing Sent To:(Required)

Your Relationship With This Person, if the Blessing Is Not For Yourself:(Required)

City, State and Country Where This Blessing Will Be:(Required)

If The Blessing is for an Illness or a Particular Issue, Please Provide a Short Reason You Wish This Blessing to be Supported:(Required)

If not an illness or issue please type: N/A

Birthdate of the Person Being Blessed(Required)

What is the birth sex of ths person being blessed?(Required)

Female

Male

How Did You Hear About Michèle's Blessings?(Required)

Chakaura^TM Power Your Life!

Individual or Group Blessing Information Form

Blessings Request Individual & Group

From the Soul, Through the Mind, Into the Body