Thank you for taking the time to honor yourself or someone you know.

Please be respectful of this service as I offer my time and energy at no charge.

Name

Who are you nominating?

First Name

Last Name

Phone

(###)

###

####

Who are you nominating?

Myself

Someone else

If you are nominating someone else, are they are aware of your gesture?

Yes

No - please work with me to coordinate with the nominee

Message

Why are you nominating this person? Recipients are chosen at random. Any details in advance will help me to prepare my self and provide the best session possible. If you are nominating someone else, please include your contact information in the message body as well.