The Passionate Veil with Aszmara
March 13, 2010
Mail-In Registration

Print & Mail to:

Nancy Barrett
P.O. Box 465
Hebron, CT 06248
Tel. 860-604-5364

registering for:

______Seminar with Aszmara - $65  (includes show ticket)
______Extra Showcase Tickets - $15
______Video of the show - $25  (no other videotaping allowed!)

______Teacher Special: Sign up 5 students who pre-pay by March 1 and your seminar is FREE! (PRE-PAID ONLY)

______Total Fee

*Please make checks payable to: Farasha and Suad

If you wish to pay be Credit Card, please include the following information
You can telephone me with your card info, if you prefer.

Credit Card Number (VISA, MC, Discover, AmEx)___________________________________
Expiration Date:________________________

Security Code:._____________(back of card)

Signature ______________________________

Name:________________________________________________________________

Address: ____________________________________________________________

City, State, Zip:_________________________________________

Phone: ____________________________

E-mail:_____________________________