Registration Form

Please complete this form and submit. This contact information is needed in the event of a schedule change, completion certificate or to email course notes. We do not share contact information with others. Please be sure to put the exact class date you wish to attend. Many times there are numerous events or classes in the same month. Thank You.

 

Note: Your name as it appears below will be how it will appear on your Teacher's or Practitioner's Certificate.

First Name: Last Name :

Address:

City: State: Zip:

Email: Please re-enter your email address:

Telephone:

Class Name: Class Date:(mm/dd/yy)

Check here if attending free meditation and indicate the date (mm/dd/yy)

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Amount of Class Fees   Payment must be in US Dollars.
 NOTE: At this time remittances via PayPal  are no longer possible due to PayPal 2019 policy changes that violate person information.


I have mailed you a Check (made payable to Cynthia Smith, PO Box 41 Lenoir City, Tennessee 37771-0041


If you were told about the classes by a friend, please give their name so a Thank You can be extended.

 

 

Notification:

I understand that information on this website or in classes is provided for informational use only.  I acknowledge that Cynthia Smith is not a trained or licensed health care provider and does not provide medical advice, diagnosis or treatment. It is always strongly recommended to consult your health care professional regarding symptoms you experience.

 

Check here to acknowledge reading the above notification. 

Please add any additional comments here




Register and send payment by deadline date noted on Class Schedule page to confirm your space in the class or event.


  All Classes or Events require registration and pre-payment. Please note that payment must be received on or before the registration/payment deadline date as noted on the class schedule page. It is necessary to receive class registration and payment by noted date as course notes and teleconference call- in number is sent a few days before each class. If you missed the deadline date, email Cindy to see if class is full. Class Payments are by check  only to keep our fees low - please mail so that it reaches me before or on the final date requested. When I have all registrations and payments, I email the course notes to the entire class. So promptness is always appreciated by your class group as well.



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