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 __________________
CVV number on back ______
Name on Card _______________________________________
Please CIRCLE which Seminar your payment is for.
SEMINAR #48A, January 9 - January 13, 2023
SEMINAR #48B, January 16 - January 20, 2023
SEMINAR #48C, January 23 - January 27, 2023
SEMINAR #47A, October 17 - October 21, 2022
SEMINAR #47B, October 24 - October 28, 2022
Please CIRCLE which AMOUNT
your payment is for.
Deposit: $150.00
Balance $400.00
TOTAL $550.00
Please mail this to:
Mary Carole
7050 Lewis Lane
San Luis Obispo, CA 93401