Please print out this form and mail in with your payment
NAME ___________________________________________
ADDRESS ________________________________________
CITY __________________________STATE, ZIP __________________
PHONE ___________________________________
E-Mail address _______________________________________
Enclosed is my payment for: Please CIRCLE what your payment is for.
Credit Card # (VISA/Master only)
______________________________
Expire date __________________
Name on Card _______________________________________
Please CIRCLE which Seminar your payment is for.
SEMINAR #17A, May 12- May 16, 2008
SEMINAR #17B, May 19- May 23, 2008
SEMINAR #18A, October 20- October 24, 2008
SEMINAR #18B, October 27- October 31, 2008
SEMINAR #19A, January 19 - January 23, 2008
SEMINAR #19B, January 26 - January 30 2008
Please CIRCLE which AMOUNT
your payment is for.
Deposit: $150.00
Balance $299.00
TOTAL $449.00
Spouse $50.00
Please mail this to:
Mary Carole
7050 Lewis Lane
San Luis Obispo, CA 93401