Register for the
Meditation Brainwaves and Being Course

Date*
Date Format: MM slash DD slash YYYY
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone 1*
Phone 2
Email*
Birth date*
What is your current work or profession?*
What are your goals in taking this course?*
How did you learn about this course?*
- Email
- Mailing
- Internet
- Friends
I wish to receive Continuing Education Units (CEU's)*
- Yes
- No
Register for meditation course
- without CEU's - $200
- with CEU's - $280
Total
$0.00
After clicking Register you will be brought to a Paypal screen where you can pay with credit card or from a Paypal account.
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