(Print out the following form and mail it with your international money order or certified check to the address below)

HALLS OF HEALING INTENT REGISTRATION FORM

Name: _____________________________________________________________

Address: ___________________________________________________________

__________________________________________________________________

Email: _____________________________________________________________

Phone Number: ______________________________________________________

Comments: _________________________________________________________

__________________________________________________________________

Register me in the following course: HLTH __________________________________

Fee amount enclosed: $___________ USD

Please address your money order or certified check to: June Kaminski

Mail Payment and Completed Form to:

June Kaminski
360 East 23rd Street,
North Vancouver, BC
Canada V7L 2E5