Life Principles 101
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CONTACT INFORMATION
Name:____________________________________________________
Phone Number:_________________________________
Address: __________________________________________________
FAX Number: __________________________________
City/State/Zip: _____________________________________________
Email: _________________________________________
Tuition is $200 and is non-refundable.
Check/Money Order Enclosed Check/MO number: ___________
(Payable to LIFE 101)
Credit Card Information: Visa MasterCard Discover
Card Number: ______________________________________________
Sec. Code (3 or 4 digit)_______
Exp. Date: _____________________________________
Billing Address: ________________________________________________________
Billing City/State/Zip:
___________________________________________________________________
Billing Name: ______________________________________________
I authorize LIFE 101 to charge the following amount to my credit card:
Signature (for Credit Card payment):
_____________________________________________
Deposit: $ _________ Full
RETURN YOUR COMPLETED FORM AND CHECK/MONEY ORDER :
By MAIL: LIFE 101
1761 Franklin Chase Terrace
Henderson, NV 89012
Name:____________________________________________________
Phone Number:_________________________________
Address: __________________________________________________
FAX Number: __________________________________
City/State/Zip: _____________________________________________
Email: _________________________________________
Tuition is $200 and is non-refundable.
Check/Money Order Enclosed Check/MO number: ___________
(Payable to LIFE 101)
Credit Card Information: Visa MasterCard Discover
Card Number: ______________________________________________
Sec. Code (3 or 4 digit)_______
Exp. Date: _____________________________________
Billing Address: ________________________________________________________
Billing City/State/Zip:
___________________________________________________________________
Billing Name: ______________________________________________
I authorize LIFE 101 to charge the following amount to my credit card:
Signature (for Credit Card payment):
_____________________________________________
Deposit: $ _________ Full
RETURN YOUR COMPLETED FORM AND CHECK/MONEY ORDER :
By MAIL: LIFE 101
1761 Franklin Chase Terrace
Henderson, NV 89012