Ayruvedic Head Massage Registration Form

Ayruvedic Head Massage Class

Registration Form
Please print this form, fill it out and send with your check or money order to:
Mystical Sciences Institute
P.O. Box 1146, Evanston, IL 60204

Date of Class:	December 7 Sunday
Time of Class:	1:00-6:00pm
Location:	MSI Classroom Great Hall of Learning 2153 Ashland Ave. Evanston IL. 60201
Name
Address
City, State & Zip
Telephone
Email address
Correct name for certificate
Total Amount Submitted	$	Check or Money Order #

The Fee is $125.A non-refundable deposit of $50.00 is required to hold your seat.
All students must be registered and paid in full by December 7 2008.
There is a limited amount of seating and classes fill up quickly so please mail this form in
with your deposit. You will receive a confirmation call following the receipt of your registration.
Visa/MC/American Express/Discover accepted.

Office use only
Date Rec'd	initials of staff member recording info
Date Data entry complete	Date confirmation call	date Filed/assigned books & material