Touch Initiative

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Human Development
Experiences
Bodywork
What's Happening
About
Contact

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YOUR CART

Touch Initiative

Know someone deserving of a little "me-time?" We are now taking nominations.
Winners will receive a free bodywork session. (Services to be redeemed in the Eau Claire, WI area)
*All nominators will be entered to win a gift certificate for themselves as well.*

* Indicates required field

Nominator's Name *

First

Last

Please provide your contact information, as the nominator.

Company Name (If applicable) *

Nominator's Email *

Nominator's Phone Number *

Nominator's age? *

15-18 19-25 26-35 36-50 Over 50

Name of Nominee *

First

Last

Please provide the information of the person deserving of free bodywork!

Your Relation to the nominee *

Family member Friend Co-worker Other

Nominee's Email (if known) *

Nominee's Address *

Line 1

Line 2

City

State

Zip Code

Country

Personal or work address can be used.

Nominee's Phone Number *

Nominee's Age *

15-18 19-25 Option 326-35 36-50 Over 50

Reason for nomination *

Please provide 1-2 paragraphs stating your reason for nominating this person for Touch Initiative.

Upload File *

Max file size: 20MB

Any additional/relevant information/pictures, please upload here.

Additional Comments *

Do you wish to be anonymous to your nominee? *

Yes No

I agree to receiving marketing and promotional materials

Submit

Stay in the Loop

Kaleidoscope Soul
Human Development • Community • Bodywork

Eau Claire, Wisconsin
[In-person bodywork by appointment only]
Phone: 201-485-6402 I Email: [email protected]

YOUR CART

Touch Initiative

Stay in the Loop

Kaleidoscope SoulHuman Development • Community • Bodywork

Kaleidoscope Soul
Human Development • Community • Bodywork