Energy Based
Healing Certification Class
Registration
Form
Please print this
form, fill it out and send with your check or money order to:
2153 Ashland Ave Suite #3 Evanston IL 60201
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Date
of Class:
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January 18 2009 Sunday |
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Time
of Class:
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1:00-6:00pm |
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Location:
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2153 Ashland Ave. Evanston IL. 60201 |
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Name
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Address
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City,
State & Zip
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Telephone
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Email
address
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Correct
name for certificate
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Total
Amount Submitted
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$
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Check
or
Money Order # |
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Class Fee $125.00 .A non-refundable deposit of $50.00 is required
to hold your seat.
All students must be registered and paid in full by January 18 2009.
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.
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Office
use only
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| Date Rec'd | initials
of staff member recording info |
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| Date Data entry complete | Date confirmation call | date
Filed/assigned books & material |