STUDENT REGISTRATION FORM
LAST NAME______________________
FIRST NAME______________________
ADDRESS_________________________
CITY STATE ZIP___________________
HOME PHONE_____________ WORK PHONE____________
FAX______________ DATE OF BIRTH______________
EMAIL______________ SOCIAL SECURITY #_______________
EMERGENCY CONTACT_________________________
3 YEAR COURSE
Self Healing 4 weeks in Year 1
Healing Others 4 weeks in Year 2
Spiritual Mastery 4 weeks in Year 3
Option 1: Per Year Basis
REGISTRATION FEE (non-refundable) $ 50.00
COURSE MATERIALS $ 100.00
TUITION DEPOSIT $2100.00 due at time of registration
TOTAL AMOUNT ENCLOSED $2,250.00
PAYMENT
TUITION TOTAL $3200/yr
Less Deposit 2,100.00
Balance $1,100 due one week prior to first day of second session each year
Option 2: Per Course Basis
REGISTRATION FEE (non-refundable) $ 50.00
COURSE MATERIALS $ 25/class
$950/5 day course
$300/5 day course -Room and Board
TOTAL COST $1,325/class ($1,025 w/o Room and Board)
Payment must be post-marked one month prior to start of course
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 10 days prior to
start date of the course.
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.
