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Debby Vajda, LCSW-C
Complex Instant
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Application to join the Energy Therapy Network

Please fill out the form below and return either by e-mail or regular mail. Please also send $5, payable to Shawn Adler. You will be listed in the next edition of the directory. Additionally, if you have e-mail, you will be added to the listserve group, which you can unsubscribe from at any time. (Please only include your home address and/or phone number on this form if its okay to include it in the directory).

Send to:
Shawn Adler
800 Lake Windermere Ct. 
Great Falls, VA 22066



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