Class Registration and Payment

Class*

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

First Name*

Last Name*

Referred by

Payment
Please provide credit card information or check number

Credit Card Number
We do not currently accept American Express

Exp. Date

Security Code

Name as it Appears on Card*

BIlling Address (incl. Zip)*

Check number
Please provide check number and bring to Wed night class or to first class of session

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 or check will be deposited.

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*