PathFinder Chang Class Registration

Mary Lewis, 2304 Hancock Dr. #7C, Austin, TX  78756

Registrant Information

Street Address:____________________________________________________________
City: ____________________ State:__________________ Zip:________________
Phone Contacts: (Please indicate preferred number)
Day:_______________   Evening:_______________   Mobile: _________________
E-Mail Address(es): (Please indicate preferred address if more than one)
Where did you hear about PathFinder Chang classes? ______________________________
Clearly print your name exactly as you would like it to appear on your Chang certificate:

Registration and Deposits
If you are making one total payment for multiple participants, please submit a separate registration form for each registrant.

Check Class Date(s) Total
Deposit  Amt Enclosed
Level 1 O Sept 11  O Oct 9  O Nov 13 $175 $75
Level 2 O Sept 12  O Oct 10  O Nov 14 $200 $100
Level 1 & 2 Intensive O Sept 11-12  O Oct 9-10  O Nov 13-14 $350 $100
Level 3
Master Practitioner
O Aug 14  O Sept 18   O Oct 16   O Nov 20 $225 $100
Level 3
Master Teacher
 O Aug 15  O Sept 19   O Oct 17  O Nov 21 $550 $150

  Total Enclosed ____________

   Balance Due _______________

Check type of payment:
O Check    O Money Order    O PayPal   Date Posted to PayPal________________

Please Note:  Full payment is required if you are paying with PayPal.
Make checks or money orders payable to Mary Lewis

Mail registration form with deposit to:
Mary Laymon/PathFinder
2304 Hancock Drive, Ste. 7C
Austin, TX  78756