Printable Registration Form

All prices are in US Dollars

Title of workshop you will be attending:

Your Name:



E-mail Address:

I give my permission for my contact info to be shared with the speakers and other participants. Yes        No


Birth Data: (Optional for Astrology Workshops)

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

Year of Birth: (1951)

Time of Birth: (11:34 am)

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

For Astrology Workshops only: I give my permission for my birth data to be shared with the speakers and other participants at the workshop.
Yes        No


Rick Levine - Shared Occupancy Only - Bali- $1,575 ($1,638 Paypal/CC)

Rick Levine - Tuition Only- Bali - $1,200 ($1,248 Paypal/CC)

FAS, India - Single Occupancy - India - $2,345 ($2,439 Paypal/CC)

FAS, India - Shared Occupancy - India - $1,825 ($1,898 Paypal/CC)

FAS, India - Tuition Only - India - $1,500 ($1,560 Paypal/CC)

Shared Occupancy Borobudur Tour (payment in full is required at registration) - $675 ($494 PayPal/CC)

Single Occupancy Borobudur Tour (payment in full is required at registration)- $725 ($546 PayPal

Single Occupancy Hampi Tour - $650 ($676 PayPal/CC)

Shared Occupancy Hampi Tour - $550 ($572 PayPal/CC)

I am paying for this package in full

I am making a deposit for this package
(minimum $500 USD)

Amount I am paying now:

I will be paying via:

PayPal or Credit Card

Once you submit your registsration form you will be directed to a page for PayPal payment or credit card payment via the PayPal site.
*Note: Due to conversion fees, PayPal is not accepting American Express cards from Australian residents. Other cards, however are accepted. We are sorry for any inconvenience this may cause.

Direct Bank Deposit

Please Contact Evelyn directly for the account and routing details.

I learned about the Heaven and Earth Workshops from:


All payments through PayPal incur a 4% additional charge, including Credit Cards.

Make a payment
A minimum deposit of $500 is required at registration.
Registrations after the deadlines must be accompanied by payment in full.

The following penalties will apply on all cancellations:
Minimum fee $500 per person
31-75 days prior to workshop - 50% of package price
0-30 days prior to workshop - 100% of package price

If you have any questions, please contact Evelyn Roberts at: