Friday, October 28, 2 pm – 5:30 pm
Saturday and Sunday, October 29-30, 9 am – 5 pm
Space is limited: First 24 registrants only
3 ways to Participate (circle one):
Attendance Option #1: Friday afternoon only, $50
Attendance Option #2: Friday and Saturday, $150
Attendance Option #3: Friday, Saturday & Sunday, $225
Name: ____________________________________________________
Email Address: _____________________________________________
Best Telephone: Day _________________ Evening _______________
Mailing Address (street, city, state, zip): __________________________
_______________________________________________________________
Payment (choose one option below; amount should match Attendance Option you chose above):
1) Check # ___________ enclosed for $ _________
Make check to Myopractic Institute OR
2) Charge $_______ to my credit card (MasterCard or Visa only)
#______________________________ Exp date: ________
Signature: ________________________________________
NOTE: Your credit card will show charge from Myopractic Institute ____________________________________________________________________
To secure your place at Becoming Still . . .
please return this completed form with payment in full by —
(1) Mailing to: 3011 Hwy 30 W #101-222, Huntsville, TX 77340 OR
(2) Faxing to: 936-435-1379 OR
(3) Emailing to: info@cynthiazaal.com
You will receive a confirmation email as soon as we receive your registration. For questions, call Cynthia at 936-435-1329. Welcome!