Registration Form

---

(Please print clearly)

Name: _________________________________________________________

Address: _______________________________________________________

City: __________________ State: ______ Country: _______ Zip:__________

Home Phone: ___________________

Work Phone: ___________________

Cell Phone: ________________________ Email: _______________________

---

Please print this form and fax/mail it to the Lotus Institute at least 2 weeks prior to class.

Credit Card Information
	Visa / MasterCard (please circle)
Credit Card No.:
Expiration Date:
Cardholder’s Name:
Cardholder’s Signature:

Please register me for the following:

Golden Path Workshop: ______ $375.00 Date:_________

Face Rdg. Intensive: 2 day_____$750.00 4 day_____$1,500.00 Date:_________

Feng Shui Intensive: 2 day_____$750.00 4 day_____$1,500.00 Date:_________

Method of Payment;

______ Please charge my credit card the full amount of ________

______ I am sending a check for ________

Please make checks payable to Lotus Institute, Inc.

Mail registration form with payment to:

Lotus Institute, Inc.,

P.O. Box 3054

Kirkland, WA 98083

Office: (001) 425.893.8984

Fax: (001) 425.822.6296

Email: natalie@lotusinstitute.com