Introductory Energetic IQ™ Reading "*" indicates required fields First Name* Last Name* Email* Phone*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country How did you hear about the Energetic IQ™ Reading?* Waiver, Release, and Assumption of Risk* I agree to the terms of the waiver, release, and assumption of risk as stated below.This form is a legal document. It explains the assumption of any and all risks in deciding to follow the ideas, information or insight, or use of products or services, from intuitive and energy mentor, Tami Gulland, who operates as a coach and consultant through Tami Gulland also dba Tami Gulland Coaching or a representative of that Company. It is critical that you read and understand it completely. Waiver, Informed Consent, and Covenant Not to Sue I hereby acknowledge I have volunteered to participate in a paid or unpaid session, class, workshop, service or program with Tami Gulland and/or an advisor available through Tami Gulland Coaching, to include, but also may not be limited to, any and all services provided, such as energy healing, intuitive coaching, guidance, classes, product and service offerings and workshop attendance. In consideration of the Tami Gulland Coaching agreement to instruct, assist, advise, or train me, I do here and forever release and discharge and hereby hold harmless the Company and its respective agents, heirs, assigns, contractors, and employees from any and all claims, demands, damages, rights of action or causes of action, present or future, arising out of or connected with my participation in a session or purchase or any program WITHOUT LIMITATION, WHICH MAY OCCUR AS A RESULT OF following advice tendered and released or training rendered or use of facilities during a session or event. I recognize that in no way does any member of Tami Gulland Coaching provide legal, medical, or therapeutic advice and it is my responsibility to secure such advisement. I acknowledge and agree that I assume the risks associated with any and all activities, offerings, products, services, classes and/or programs in which I participate or purchase. I acknowledge and agree that no warranties or representations have been made to me regarding the results I will achieve from any insight, guidance, product, service or program. I understand that results are individual and may vary. I further acknowledge I am granted permission to audio record my sessions with Tami Gulland for personal use only. I understand that I MAY NOT share my recordings privately or publically in any form, as to do so would violate the terms of this agreement, breach trust, and break a code of privacy. Any unauthorized use, sharing, broadcast or release, personally or publically, in any form, of a recorded session, is strictly prohibited and would be considered an illegal act and punishable by law. I ACKNOWLEDGE THAT I HAVE THOROUGHLY READ THIS WAIVER AND RELEASE AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. BY SIGNING THIS DOCUMENT, I AM WAIVING ANY RIGHT I OR MY SUCCESSORS MIGHT HAVE TO BRING A LEGAL ACTION OR ASSERT A CLAIM AGAINST TAMI GULLAND AND TAMI GULLAND COACHING FOR NEGLIGENCE OR THAT OF ITS EMPLOYEES, AGENTS, OR CONTRACTORS. The Introductory Energetic IQ™ Reading is non-fundable. The Special introductory reading rate is available once for first time clients only.Introductory Energetic IQ™ Reading* Price: Total Privacy* By using this form you agree with the storage and handling of your data by this website. *