STUDENT REGISTRATION FORM
LAST NAME
FIRST NAME
ADDRESS
CITY STATE ZIP
HOME PHONE WORK PHONE
FAX DATE OF BIRTH
EMAIL SOCIAL SECURITY #
EMERGENCY CONTACT
7 MONTH COURSE
Self Healing 4 weeks
Healing Others 4 weeks
Spiritual Mastery 4 weeks
Healing Practitioner 12 week Practicum
COURSE MATERIALS $ 200.00
TUITION DEPOSIT $1000.00
TOTAL AMOUNT ENCLOSED $1,250.00
Payment must be postmarked one month prior to start date to avoid late fee of $50.00.
PAYMENT
TUITION TOTAL $10,000.00
Less Deposit 1,000.00
Balance $9,000.00
$4,500.00 due on first day of class
$4,500.00 due on or before first day of class
PAYMENT METHOD
Visa Master Card Check Money Order
Credit Card Number:
Exp. Date: AMOUNT
Name (as appears on card)
Billing Address (Street Address, City State, Zip Code)
_________________________________________________________
Signature of Card Holder
PLEASE COMPLETE THIS FORM AND RETURN WITH PAYMENT.
I agree that if for some reason I cannot keep this commitment $500.00 of my tuition deposit will be refunded to me if I notify the office one week prior to the session date.
After that date, I agree the tuition deposit and the fee for course materials becomes non-refundable and no money will be refunded under any circumstances.
Student signature Date
Name (Please print)
Please submit original and keep a copy for your records.
TUITION COSTS
The Heart Awakening School of Healing has done its best to maintain the high quality and standards of the work while keeping its fees as affordable as possible.
