REGISTRATION FORM
COLOURWORKS Introduction to the Kabbalah TREE OF LIFE
Please make sure we receive this form with your $50 DEPOSIT no later than September 25, 2007. Email: colourworks@luminanti.com, Fax: 919-563-1522, Mail: Anne Christine Tooley, 4402 Bradford Ridge Rd., Efland, NC 27243. This information is confidential and will be used only by the administration and teachers of Colourworks.
Date: ______________________ Name : ________________________________________________________
Address: ___________________________________________________________________________________
Daytime Phone : __________________ Evening Phone: ___________________ Fax: ___________________
Courses you are attending: __________________________________________________________________
Amount Enclosed: _____________ Email: ____________________________________________________
Payment Method: Visa or Mastercard Debit/Credit Card Money Order Check
Credit/Debit Card Type: VISA MASTERCARD Credit or Debit Card: Credit Debit
Credit/Debit Card # _________________________________________ Exp. Date (mm/yy) _____/_____ CVV2 # ________
SIGNATURE: _________________________________________________________________________
Occupation: __________________________________________________________________________
Professional Skills: ____________________________________________________________________________________
Would you like flyers, letters, etc. sent via email? YES NO
What would you like to learn and experience from this course? Will you be using it personally, professionally and/or with family & friends? How would you like to incorporate Kabbalah and the Tree of Life into your life and/or practice? How can we be of support?
OPTIONAL (for relating Colourworks to your Astrology Birth Chart): Birth Date (mm/dd/yy) ______________________
Birth Time: _____________ AM PM Birthplace: ________________________________________
EMAIL to: colourworks@luminanti.com ~ FAX to: 919-563-1522 MAIL to: Anne Christine Tooley, 4402 Bradford Ridge Rd., Efland, NC 27243