Ambassador Registration

How to Register for a new Ambassador Account?

If you are an existing Ambassador, please use Form 1 below, using your current Ambassador Login Details.

If you are not currently an Ambassador, please use Form 2.

If you are not currently an Ambassador, please use Form 2, which is located underneath Form 1, further down the page.

Form 1 – Existing Ambassador

Form 2 – Join Ambassador Program

"*" indicates required fields

First Name*

Last Name*

Email*

Phone*

How can we help you today?*

What is your main motivation for wanting to participate/ join?*

What are your goals for this workshop?*

This is a substantial investment in your future. How would you best describe your commitment level right now?*

I am committed to my journey and ready to invest in me

I still have a few questions to see if this is 100% for me

I am not ready to make a commitment but possibly in the future, so keep me updated on future events.

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Event Name

Name

This field is for validation purposes and should be left unchanged.

Sign up to receive free meditations, ancient wisdom, energy transmissions, and a chance to win a free healing session every month.

Platinum Package

"*" indicates required fields

Name*

First Last

Email*

Phone*

Which of the options are you interested in for the Platinum Package:*

Coaching Sessions

Private Healing Sessions

Home Cleansing & Energy Balance

Energy Flow at work/business

Nutritional Guidance

Exercise Guidance

24/7 Access to Jerry Via Whatsapp

This field is for validation purposes and should be left unchanged.

Healing For Horses Enquiry Form

"*" indicates required fields

First Name*

Last Name*

Email*

Phone*

How can we help you today?*

What is your main motivation for wanting to participate/ join?*

What are your goals for this workshop?*

This is a substantial investment in your future. How would you best describe your commitment level right now?*

I am committed to my journey and ready to invest in me

I still have a few questions to see if this is 100% for me

I am not ready to make a commitment but possibly in the future, so keep me updated on future events.

This field is hidden when viewing the form

Event Name

Comments

This field is for validation purposes and should be left unchanged.

Event Enquiry Form

"*" indicates required fields

First Name*

Last Name*

Email*

Phone*

How can we help you today?*

What is your main motivation for wanting to participate/ join?*

What are your goals for this workshop?*

This is a substantial investment in your future. How would you best describe your commitment level right now?*

I am committed to my journey and ready to invest in me

I still have a few questions to see if this is 100% for me

I am not ready to make a commitment but possibly in the future, so keep me updated on future events.

This field is hidden when viewing the form

Event Name

This field is for validation purposes and should be left unchanged.