© Copyright 2006 E. Jack Lemon
information@addictedtocertainty.com
734-770-4566
The Reality School
Seminar Registration Form
Bear Creek Farm
9501 Dundee/Azalia Rd
Maybee, MI 48159
734-770-4566
* Required Fields
*First Name:
*Last Name:
*Street Address:
*City:
*State:
*Zip Code:
*Phone Number:
*E-mail Address:
Cost of Seminars
at  Bear Creek Farm
$25.00 each
Workshops V Must Be Taken Before Any Seminars
Seminars and
Special Events
Select Date
Sweat Lodge Ceremony
Seminar
Seminar
Seminar
Seminar
Submission of this form is only for
Credit Card Transactions
The Reality School
will send you an
E-mail Invoice through PayPal
for a secured payment
(A PayPal membership is not necessary)
Bear Creek Farm
If paying by check, please send check payable to:
"Addicted To Certainty"
along with printed registration form to:

The Reality School
Bear Creek Farm
9501 Dundee/Azalia Rd.

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Registration by phone at: 734 - 770 - 4566

Schedule





Registration