Space is Limited in this Workshop. Register EARLY to ensure your attendance.

PLEASE MAIL, e-MAIL OR FAX THIS FORM TO CLEAR LIGHT ARTS, ADL
Ken Page/Nancy Nester
PO Box 1500, Cleveland, GA. USA 30528
Tel: 706-865-0322 (ofc), Fax: 706-223-0291
CONTACT US

Name: _________________________________________________________________________

Address: _______________________________________________________________________

City: _______________________________________ State: ___________ Zip: ______________

Daytime telephone: _______________________________________________________________

Evening telephone: _______________________________________________________________

Fax: __________________________________________________________________________

e-mail: ________________________________________________________________________

Pre-Requisite for Attendance: Read Ken and Nancy's Philosophies of Oneness

Prior Institute of Multidimensional Cellular Healing / Heart & Soul Healing Workshop attended,
including location and date:

_______________________________________________________________________________

_______________________________________________________________________________

Have you experienced a Heart & Soul Healing private session? If yes, provide the month/year and with whom:

_______________________________________________________________________________

_______________________________________________________________________________

METHOD OF PAYMENT

_____MONEY ORDER _____CHECK_____MASTERCARD _____VISA

All credits card orders will be charged through our business name: CLEAR LIGHT ARTS, ADL.
Upon request, tuition paid to our 501(c)(3) not-for-profit organization will receive a tax deductible receipt for the full tuition price.
Space is limited in this workshop. A minimum deposit of $100.00 is required for your attendance.

Credit card number: ______________________________________________________________

Exp. Date: ____________

Name as it appears on the credit card: ________________________________________________

Signature: ______________________________________________________________________