| Workshop Registration Form: |
| Please use this form for secure credit card registration for the April 12th & 13th, 2008, Becoming the Human Crystal workshop in Dundrum, Northern Ireland; OR call (028) 437 51 951 to register by phone or post!
We accept Visa, Mastercard, American Express, or Discover/Novus cards. The workshop fee is $366.00 (£175.00). This fee is for the workshop only. Meals, lodging and travel are not included.
A very limited number of private Crystal Ally Card Reading sessions with Naisha will be available following the workshop. The private sessions are $106.00 (£50.00) for one hour. Please indicate if you would like to reserve a private session below. Sessions are available on a first come, first served basis.
All registrations will be billed in US dollars according to the exchange rate as of 07/15/07 (the date this registration form was created).
Pre-registration is required! This workshop is limited to 15 participants and space will be awarded on a first come, first served basis. Thank you!
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Name of Participant: |
(This is the name of the person attending the workshop) |
E-Mail Address: | (valid email address required to confirm registration) |
Telephone (with country code): | Day Evening |
Name on Card: | (Name exactly as shown on card) |
Card Billing Address: | (as shown on your monthly card statement) |
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Credit Card Type: | |
Card Number: | (Please do not include any spaces or dashes) |
Security Code | (3 digits on the back of the card at the end of the signature strip) |
Expiration Date: |
Month (MM)
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Year (YY)
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Special Instructions (if any): |
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I would like a private session with Naisha, please charge me accordingly!
YES NO
(Please be sure you have selected NO if you do not wish to be charged for a private session in addition to the workshop fee)
If you selected to reserve a private session with Naisha above, please choose the preferred day below.
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