Class Registration and Payment

Class*

Chart Reading date, if applicable
If paying for a chart reading, please include your scheduled date

First Name*

Last Name*

Referred by

Payment
Please provide credit card information

Credit Card Number
We do not currently accept American Express

Exp. Date

Security Code

Name as it Appears on Card*

BIlling Address (incl. Zip)*

Contact Information

Phone Number*

Email Address*

Birth Information

Birth Day*

Birth Place*

Birth Time*
Please indicate if time is exact or estimated

Agreements:

By clicking here you acknowledge that you are making a binding commitment to a space in the class and that you understand that your card will be charged.

Agree*

I am aware that my payment is non-refundable, though it may under certain circumstances be transferable to another Awareness Institute class or workshop.

Payment Agreement*