City of Orem Reiki Form

Thank you for applying for a business license with the City of Orem. In order to complete your application, please answer the following questions fully and truthfully.

What is reiki? Please provide a description of reiki as you plan to practice it.

What training have you received in "reiki?" Are you accredited by a nationally recognized reiki organization, if such an organization exists?

Are you a licensed massage therapist under the Massage Practice Act?

Yes

Will you be performing massage services in Orem?

Yes

Will your patrons remove any articles of clothing? Will you remove any articles of clothing? If so, please indicate what clothing will be removed.

Will you touch clients, customers, or guests at any time? If so, please indicate what you will use.

Will you advertise your services? If so, how will you advertise? How will you describe your services?

Will you comply with all applicable federal, state and local law?

Yes

I acknowledge that this addendum is a part of my application to be licensed to do business in Orem. I affirm that all statements in this application are true and correct. I understand and agree that any false statements in this addendum, in my application, or in any conversations with city staff are cause for suspension or revocation of my business license.

Please submit your application now. The portion below will be filled out in-person in the Orem Business Licensing office in the presence of a registered notary public.

If you have any questions about his process, please call Orem Business Licensing at 801-229-7052

Printed Name: ________________________________________

Signature: ____________________________________________

STATE OF UTAH )

: SS.

COUNTY OF UTAH )

On this _________________ day of ______________________, 20____, personally appeared before me _________________________________, whose idenity is personally known to me or proved to be on the basis of satisfactory evidience, and who executed this document in my presence.

____________________________

Notary Public