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To apply for this intensive, submit the following items along with your completed registration form and payment-in-full. Please submit all items together at the time of application.

• A recent head & shoulder, individual color photo.

Registration Form

Name_______________________________________________

Address_____________________________________________

City________________________________________________

State/Prov_____________Zip____________________________

Home Phone__________________________________________

Work phone__________________________________________

Email_______________________________________________

Name for ID Tag______________________________________

Emergency Contact Name__________________________________

Emergency Contact Phone#__________________________________

$1350 Regular Fee

Check # ______ payable to HLCC and/or

MC Visa Disc AMEX
CC#_________________________________Ex. Date________

Dietary Preference:
All foods Vegetarian, including dairy & eggs (Sorry, we cannot accommodate special diets ).

Sunday Arrival:
I will arrive in time for 5:30 P.M. dinner on Sunday.

To register for this workshop please fill out the form above and mail it
along with your payment AND color photo to the following address.

The Healing & the Changing Universe Class
Healing Light Center
261 E. Alegria Av., #12
Sierra Madre, Ca. 91024

Questions? Please feel free to phone HLCC at (626)306-2170.