DYNAMICS OF CONSCIOUS LIVING                     (630) 777 6926

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REGISTRATION FORM

IMPORTANT - PLEASE READ:  Complete this form for each person attending.  If you are registering with another person to qualify for the 'group' discount, then enter that persons name, address, e-mail address and daytime phone/cell number in the "Comments" section. Unless you are using your credit card to pay for the both of you, then we will also need a separate form for your friend.   Once all information has been filled in,  then hit the "Submit" button to be taken to the page to safely and securely register with  Pay Pal.

First Name:
Last Name:
Address:
Apt./Suite:
City:
Zip Code: (5 digits)
State:
Daytime Phone:
Cell Phone:
Email:
Comments: