Remote Session Registration
If you wish to receive a session, please fill out the details below.
Name _________________________________ Today's Date _____________
New Moon ____ Full Moon ____ New Year's Eve ____ New Years Day ____ Holiday Package ____
Check ____ Money Order ____ Pay Pal ____ (for Pay Pal payment, add 5% to total)
Signature _____________________________________
Quantity . . . . . . . . _____________ @ Suggested Price: $175.00 ea. _________
with feedback*: $500.00 ea. _________
holiday package: $649.00 ea. _________
Total $ __________
* Subject to availability
Credit card payments are accepted, and payment through PayPal is available. Please go to www.paypal.com. When you arrive at the “Send Money” option, enter in this email address: This email address is being protected from spambots. You need JavaScript enabled to view it. . You will be required by PayPal to set up an account with them. Be sure also to e-mail your request to This email address is being protected from spambots. You need JavaScript enabled to view it. .
If you are using Pay Pal, make sure that the Recipient is The Center For Contemplative Awareness.
Checks should be made payable to The Center for Contemplative Awareness.
Checks may be mailed to: The Center for Contemplative Awareness
7529 Sunset Blvd.
Los Angeles CA 90046 USA For any questions or inquiries please contact Kirpal, Vice President of the Center for Contemplative Awareness.
E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it. fax: 323-436-0831 phone: 323-436-0264
Your Complete Address _______________________________________
____________________________________________
____________________________________________
Telephone Numbers: Day (____) ______________________________
Evening (____) _______________________________
Mobile (____) _______________________________
Fax (____) _______________________________
E-Mail Address ___________________________________ @ _____________________