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Registration (& Book Order) Form
Print this form, complete and send it
with payment
to
LEARN TO VISUALIZE, 106 ILA Lane, Columbia, SC 29206.
Credit card registrations/orders may be faxed to: (803) 782-0462.
Note:
Paid registration is required to hold your space.
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Selection:
Please place a check next to your choice(s) below: |
Fee/Price |
Amount |
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Register for the
Consciousness Study Group to begin October 7, 2007. |
130.00 |
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SC residents
only—Order a copy of The Art
of Creative Visualization: A Self-Teaching Workbook
($24.95 + 5.35 shipping & handling + 1.52 sales tax)
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31.82 |
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Total Enclosed
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Complete the following. Please print clearly.
Name
___________________________________________________________________
Mailing Address
___________________________________________________________
________________________________________________________________________
Phone (_______)__________________
Work or Cell (_______) __________________
Email ___________________________________________________________________
Method of Payment: _____Check
_____Visa
_____MasterCard
Credit Card Number: _________________________________
Exp. Date:_____________
Security Code: _____________
The security code is the last 3 digits of the number printed
on the signature strip on the back of your credit card.
Cardholder's Signature:
______________________________________________________ |