Lotus Institute Inc., of Lillian Bridges
Please print
Name:
____________________________________________________________
Address:
__________________________________________________________
City:
Home Phone:
____________________Work Phone: _______________________
Cell Phone: ________________________
Email:__________________________
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Credit
Card Information |
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Visa______
Mastercard_______ |
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Credit Card No.: |
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Expiration Date: |
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Cardholder’s Name: |
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Cardholder’s Signature: |
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Please register me for the
following:
______ Golden Path Workshop - Date:
______________$375
______ Face Reading/Diagnosis Certification -
Date: __________________
2 days _____ $1000 USD 4 days _____ $2000 USD
______ Five Element Feng Shui
Certification – Date: __________________
2 days _____ $1000 USD 4 days _____ $2000 USD
Method of Payment:
______ Please
charge my credit card a deposit of $________.
The
balance is due 30 days prior to the first day of class.
______ Please
charge my credit card the full amount of $________.
______ I am sending a check for $________.
Please
make checks payable to Lotus Institute, Inc.
Mail
registration form with payment to:
Lotus Institute, Inc.
Office/Fax #: (001) 425.822.6296