Print out and complete this form and return with your fee made out to
Alana Kapell
4608 Red Maple Lane, Inverary, Ontario K0H1X0
Phone: (613) 353-6504 email: heartmerkaba@gmail.com
AWAKENING THE ILLUMINATED HEART WORKSHOP
Name: ___________________________________________
Male: ____ Female: ____
Phone:________________________
E-mail: ___________________________
E-mail: ___________________________
Address: _________________________________________
City: ________________ Province: ___ PC: _____________
Along with this application, please include your workshop fee down payment of $111.00, the final payment of $333 is due OCTOBER 24/2011.
Your fee is non-refundable if you have to cancel after October 24 (fully refundable if the class is cancelled). However, it may be applied to a future workshop. Ron has to book his flight and accommodation and we make reservations for the space for the workshop. We are responsible for your space even if you drop out. Let us know if there is a change in your situation as soon as you can, and we will do everything we can to help you.
I am paying by Check/money order in the amount of _______ Cnd and it is enclosed.
Make check/money order out to ALANA KAPELL
Make check/money order out to ALANA KAPELL
You may also pay by PAYPAL on Ron LaPlace’s website at http://ronlaplace.com/awakening-the-illuminated-heart/
Signature: _________________________
Date:_____________________________
