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 #25A, January 16 - January 20, 2012
SEMINAR #25B, January 23 - January 27 2012
SEMINAR #26A, October 15- October 19, 2012
SEMINAR #26B, October 22- October 26, 2012
Please CIRCLE which AMOUNT
your payment is for.
Deposit: $150.00
Balance $350.00
TOTAL $500.00
Spouse $50.00
Please mail this to:
Mary Carole
7050 Lewis Lane
San Luis Obispo, CA 93401