Feng Shui Registration Form

Sacred Spaces and Personal Feng Shui

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:	Saturday, June 5 & 12
Time of Class:	1:00pm - 4:00pm
Location:	MSI Center, 2144 Ashland Ave. Suite #7, 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 $125.00. A non-refundable $100 deposit is required to reserve your program seat.
There is a limited amount of seating and classes fill up quickly so please mail this form in
with your deposit. The Program Fee is due by or at the first class June 5, 2004.
You will receive a confirmation notice following the receipt of your registration.
For your convenience, we are now accepting, Visa, Mastercard or American Express.

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