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.
TODAY'S DATE: _________________________________________
FIRST AND LAST NAME: _________________________________________________________________
ADDRESS: _______________________________________________________________________________
CITY: ________________________________________ STATE: _____________ ZIP: _________________
PHONE with Area Code: ____________________________________________________
EMAIL: ______________________________________________________________________
Please check one:
____ CLASS 1: Intro to Esoteric Healing
____ CLASS 2: Integrated Living
____ CLASS 3: A Cosmic Perspective
____ CLASS 4: The Bridge Of Light
____ All 4 classes
ENERGY HEALING TREATMENT
____ 1-Hour Treatment $70.00
____ 30-min. Treatment $50.00
Please check amount you are enclosing:
____ Full Class Fee $490
_____ Early Registration $440 (4 wks prior to class start date)
____ Class Repeat Fee: $150
____ $50 Deposit (non-refundable) reserves your space
____ Balance to be paid on or before first day of class
____ 3 classes for the price of one Fee: $1470
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.