Foundation for "A Course in Miracles" - Main Center Registration Form

REGISTRATION FOR THE MAIN CENTER—TEMECULA

PERSON 1:
Name
Address
City/State/Zip
Day Phone
Evening Phone
Email Address

PERSON 2:
Name
Address
City/State/Zip
Day Phone
Evening Phone
Email Address

1) CALCULATE YOUR PAYMENT AMOUNT
Please refer to the Schedule of Events for the program fees.
Program Number	Fee
	Person 1: $ Person 2: $
	Person 1: $ Person 2: $
	Person 1: $ Person 2: $
	Person 1: $ Person 2: $
	Total: $

Place me on a waiting list if program is filled: yes no

2) PAYMENT INFORMATION

Make check or money order payable to the Institute for Teaching Inner Peace through A Course in Miracles, or ITIP-ACIM (US funds only, drawn on a US bank), or provide credit card information to secure a place for the programs you list above.

Check or money order enclosed for $

Credit Card Information: Discover VISA MasterCard American Express

Person 1: Expiration Date: No.

CVV2/CID Number: What is CVV2/CID?

Person 2: Expiration Date: No.

CVV2/CID Number: What is CVV2/CID?

Important credit card billing address if different from above:
Person 1:
Person 2:

3) If you so choose, submit this form electrically now.

4) To mail or fax this form, please print out this screen.
Signature(s): Please sign here after printing.

5) Mail or fax the entire registration form to:

Institute
Foundation for A COURSE IN MIRACLES®
41397 Buecking Drive
Temecula, CA 92590-5668
FAX: 951.296.9117