print app to RST 5 day orientation

School of Light Body Medicine

Application to attend the 5-Day Orientation Seminar
of the Regenerative Soul Therapy Progressive Degree Program.

Please print this form from your
web browser and mail it
with the application fee to:

Rev. Magdalena Light
P.O. Box 189
Havre de Grace, MD, 21078
U.S.A.

*Select the session you want to attend:*
	April, 2004	The Seminars will be offered in Philadelphia, PA. Address, dates, and times to be announced.
	May, 2004
	June, 2004
	July 2004

*Please print the following information*:
First Name
Last Name
Street Address
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
E-mail

*Please provide the following information:*
Occupation relevant to this program
Number of years in this field
Education and Degrees

There is a $100 non-refundable application fee.

If you attend the seminar, the application fee
will be deducted from the $500 seminar fee.

If you do not attend, no refund will be provided.

Enclose Money Order (no personal checks please) or
Charge my $100 application fee to the following:
	Visa
	MasterCard

Please take this chance to donate and help me build the Temple of Living Light everywhere. No amount is too small, no amount is too big. All amounts are just right and right now. Any amount not donated is an opportunity lost in world service.

Please accept my donation of $________ to Rev. Light
to help her build the Temple of Living Light everywhere

Please note: Donations are entirely voluntary and are not related in any way to the application process.

Total enclosed:

*Credit Card Information:*
Card Number
Expiration Date
Card Holder information if different from registrant	First Name
	Last Name
	Address
	City
	State
	Zip
	Country