AVATAR® COURSE
REGISTRATION
DATES:
LOCATION:
NAME(S):
MAILING
ADDRESS:
Phone#:
E-Mail
Address:
I would
like assistance
with travel arrangements:
I am
enclosing my
deposit in the amount
of $300
for the 9 day
the ReSurfacing Workshop:
My full
tuition, in the
amount of $2,295.00,
for the 9 day
course,
which includes the
ReSurfacing Workshop
is
enclosed:
I am
registering for the
ReSurfacing
Workshop
- enclosed is my
I am
registering for the
ReSurfacing
Workshop
- enclosed is my full payment of $295
I have
completed ReSurfacing
- enclosed is my deposit of $300 for the Avatar Course
I have
completed ReSurfacing
- enclosed is my full payment of $2000 for the Avatar Course
TOTAL
AMOUNT ENCLOSED:
1.
Are you currently under any medical or psychiatric
supervision?
If
yes, please explain, include dates, duration &
outcome
2.
Are you currently taking any prescription
or recreational drugs?
If
yes, please give the name of the drug, frequency of
usage & purpose of taking.
3.
Have you ever been subject to a traumatic injury or
violent attack?
If
yes, please give details.
Message:
Please confirm that everything is correct.
The 'Send Request' button below will submit your message.
To
send request, or
To reset form.
Please confirm that everything is correct. If you want a
copy of this registration please hit the please print button
before sending the request.
Payment may be
made by cash, check or money order payable to: Avatar
Universe Please send to:
William
Lee
18265
Parkside
Detroit,
MI 48221
For
credit card payments please call
1-888-383-4810
PC,
Enlightened Planetary Civilization, and Love Precious Humanity
are all service marks of Star's Edge, Inc. Avatar®,
ReSurfacing®, Thoughtstorm® and Star’s Edge International®
are registered trademarks of Star’s Edge International. All
content copyright 2002, Star’s Edge International. All
rights reserved.
