Seminar & Workshop Registration Form

You may schedule a Seminar or Workshop by calling 516-355-6454, or by completing the following
form. Please note that after submitting this registration form, you will be taken to a confirmation
page with the OPTION to proceed to PayPal™ and submit payment for your Seminar or
Workshop Pre-registration Deposit, or Seminar or Workshop Tuition.

* Required Information

* Name:
* Email:
* Street Address:
*City:
*State:
*Country:
*Zip Code / Postal Code:
*Phone Number:
Other Phone Number:
Select the Seminar or Workshop for which you are registering:
* Registration is for:
Payment method for your Seminar Pre-registration Deposit:
Payment Method:
Please indicate payment method for your Seminar Tuition below:
Payment Method:
If you are pre-registering for the Advanced ThetaHealing™ Seminar,
the Manifesting & Abundance Seminar, or the Intuitive Anatomy Seminar,
then please provide the following information:
Name of Basic and Advanced ThetaHealing™ Instructor(s):
Dates of Basic and Advanced ThetaHealing™ Seminar(s):
Date(s) of Practitioner Certification(s):
Location of Seminar(s)
(City, State, Country):