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 #22A, October 18- October 22, 2010
SEMINAR #22B, October 25- October 29, 2010
SEMINAR #23A, January 17 - January 21, 2011
SEMINAR #23B, January 24 - January 28 2011
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