Form for Payment by Check
Kindly print this page, complete the form, enclose your check, and return to:
Claudia Rose
PO Box 873, Enosburg Falls VT 05450
Confirmation & map for classes will be provided upon receipt of registration and payment.
FIRST AND LAST NAME: _________________________________________________________________
ADDRESS: _______________________________________________________________________________
CITY: ________________________________________ STATE: _____________ ZIP: _________________
PHONE with Area Code: ____________________________________________________
EMAIL: ______________________________________________________________________
COURSE I: Intro to Esoteric Healing
Please check amount you are enclosing:
____ Full Class Fee $390
____ Register with a friend and you both
receive a $50 savings in your class fees ($340)
Friend's Name _________________________________
____ Class Repeat Fee: $100
____ $50 Deposit (non-refundable) reserves your space
____ Balance to be paid on or before first day of class
Would you like a list of local lodgings: ___Yes ___No
ENERGY HEALING TREATMENT
____ Energy Healing Treatment $70.00
If you have any questions, please contact Claudia Rose via email at
claudiarosevt@gmail.com or by phone at (802) 933-6107
Privacy Policy: We will never share, sell, or rent your personal information.