Healer Teacher II 2005 Registration Form

Healer Teacher Nomena Level II Program

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's 02/19, 02/26, 03/12, 03/19, 04/02, 04/16 Monday Nights 02/22, 02/26, 03/14, 03/21, 04/04, 04/11
Time of Class:	Saturday's 1:00-5:00pm Monday's 7:00-8:30pm
Location:	MSI Center 2153 Ashland 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 $495.00 per person.A non-refundable deposit of $100.00 is required to hold your seat. All students must be registered and paid in full by February 19, 2005.
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 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