REGISTRATION FORM

COLOUR MIRRORS
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 Colour Mirrors.

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 Colour Mirrors 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