Reiki Cranial Fascia Pratitioner Registration Form

Reiki Cranial Fascia Practitioner

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:	September 21 & 28 (two Sundays)
Time of Class:	1:00pm - 6:00pm
Location:	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 $450.A non-refundable deposit of $100.00 is required to hold your seat.
All students must be registered and paid in full by September 21 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