• Enter Today's date
  • As of January 17, 2017, you must upload a recent picture of yourself in order to receive your reading and geometric symbols. (Supported image types: .jpg .gif .png)
  • Make your selection(s) below.
  • If you were given a Discount Code, please enter it here. Also, put the discounted price that you were quoted.
  • If Applicable: Select the name of the Account Manager that you have been working with to get you enrolled into the Jewel University of Immortal Sciences (JUIS).
  • Select the appropriate avenue in which you heard about our program. If you choose "Other" please explain in the comments section. If you choose "Referral": Enter the full name, phone number, and email address of the person who referred you to the Brain Balancing Program in the comments section (This mainly applies to people that are new to the program).