JETIU PSY College Campus Specifically Speaking Series

Registration - Psychic Awareness 101A:
Course Date: April 29 to June 5 (or 12), 2002; Mon.'s & Wed.'s
Time: 6:30 PM to 9:30 PM (occasionally 10:00 PM)
Location: Back Ally Deli, Edmonton, AB, Canada
Instructors: Kimberlee Dawn and Suzanne Horner
Contact: 1-(780)-479-5052
kdawn@kimberleedawn.com
suzanneh@kimberleedawn.com



Name:___________________________________

Contact #:

Day: (____)____-______ Cell: (____)____-______ Evenings: (____)____-______

Address: ________________________________________________________

City: _______________________ Province:________ Postal Code:___________

Emergency Contact:

Name: __________________________________ #: (____)____-______

Relationship to yourself: ______________________________



Deposit Received:______________ Balance Received:______________
Date:______________ Date:______________
Method of Payment:______________ Method of Payment:______________
Student Signature:______________ Student Signature:______________
JETIU Operative Signature:______________ JETIU Operative Signature:______________