Secure Registration for Session 1 of The Eupsychia Mystery School, Sept 17-20, 2004, Des Moines, Iowa

	AUSTIN, TEXAS
	DES MOINES, IA

SECURE ONLINE REGISTRATION • SESSION #1 SEPTEMBER 17-20, 2004 • DES MOINES, IA • $495 TUITION

Name (First and Last): (If you are paying for more than one person, please fill out a separate form for each attendee. Thanks!)
Mailing Address: (include apartment numbers or suite numbers)
City:	State:
Country:		Zip/PostalCode:
Home Telephone (w/ area code):
Work Telephone (w/ area code):
Email Address: IMPORTANT!
Payment Method:
Credit Card Number:
Expiration Date:
Authorized Amount:
Additional Comments: Do you need a response to your comment? (If yes, please make sure you give us your email address and phone number in the appropriate fields above.)
Please help me find a roommate. Non-smokers of the same gender will be chosen.
How did you learn about the Eupsychia Mystery School? Previous Eupsychia Workshop Attendance Brochure Mailing Internet Search Friend Other-Please specify
By pressing the "send" button, you are authorizing Eupsychia Institute, Inc. to charge your Credit Card the amount you have indicated above... Welcome to the Mystery School! We look forward to seeing you again for Session 2 (to be scheduled) ....

If you prefer to order by phone, please call us toll-free at:

800.546.2795

Or, you can mail your check or money order to us at the following address:

Eupsychia Institute • PO Box 151960 • Austin, TX 78715

Cancellation Policy for the Eupsychia Mystery School: Your $100 deposit, less a $40 administration fee, will be refunded to you when you cancel up to four weeks (August 17, 2004) before this event. Deposits will not be refunded after this date.

NOTE: Cancellation policies vary from event to event depending on contracts that we have with the centers out of which we work.