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Name*
Age*
Address*
Email*
Phone*
Best time to contact for interview:

: Hours

Minutes
Who did your first demonstration of Seimei?*
Best time to go to Japan (January or June or August?):*
Seimei is a time, emotional and financial commitment. Why do you want to learn about your own Seimei?*
How do you plan on using Seimei?*
Please tell us a little about yourself.*
Have you been diagnosed with any health conditions? Please describe in detail.

We look forward to meeting you! Someone will be in contact with you for an interview.

The Seimei Foundation