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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
course, which includes 

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 
$100 deposit                                  

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.

                                                       Please confirm that everything is correct.  If you want a copy of this registration please hit the please print button before sending the request.  

To send request, or

 

To reset form.

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. 

EPC, 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.
Copyright © 2003 [AvatarUniverse.info]