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ONLINE REGISTRATION FORM
 
Astrological Intensive with Steven Forrest and Lynn Bell
December 6th-15th 2005
Bali, Indonesia

A $500 minimum deposit is required for registration.
Payment in full is due by September 15th, 2005
Reservations at Melati Cottages will only be confirmed upon payment in full.
 
Click here for Printable Form page.

Name:

Address:

Phone:

E-mail Address:

Birth Data: (Optional)

Date of Birth: (02/18 - month/day)

Year of Birth: (1951)

Time of Birth: (11:34 am)

Place of Birth: (New York, NY, USA)


I am registering for the:

Full Accommodation Package ~ $1,500

Full Accommodation, Single Occupancy Package ~ $1,700

Young Astrologer Full accommodation Package ~ $1,100

Tuition Only Package (for off-site participants) ~ $1,200

Young Astrologer Tuition-Only Package (for off-site participants) ~ $800

I will be paying via:

PayPal (For all credit card payments or PayPal account payments)

Check - (Mail check to:)
                                                        Astrology in Bali, c/o Evelyn Roberts
                                                        P.O. Box 783
                                                        Los Olivos, CA 93441

 

Please help us to streamline our advertising costs next year by telling us what
organization, publication, or website led you to us. Thank you!

 

 

If you have any questions, please contact Evelyn Roberts at
805.688.6789 (USA)
or at:   evelynroberts@earthlink.net

 

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