Please fill out this form to get on CJ's Session Schedule. After submitting your form you will
be provided a link to make your session payment.

Your Contact Information: Name: Street Address: City: State/Provience: Zip/Postal Code: Country: Email Address: Phone: Session Information Needed: Date of Birth (month,date,year) Do you have a photo of yourself in digital format (emailable)? A photo is not required to conduct your session - - Select One - - Yes, I do No, I do not Planned Method of Session Payment: - - Select One - - Credit Card via PayPal Check/Money Order by Mail International Money Order Type of AFT Session: (Session Types) - - Select One - - Mini AFT Session Short AFT Session Full AFT Session How did you hear about CJ?: - - Select One - - Yahoo MSN Search Google Altavista Other Search Engine Internet Radio Show A Friend Recommended Her OmPlace ByRegion.net Facebook Link From Another Website Other Comments/Specific Requests: