SCRIPT SECRETS CLASS

REGISTRATION FORM

August 28th & 29th 2004 - Embassy Suites Airport @ 24th, Phoenix

You can print and mail this form to me, or send the information in an e-mail.

NAME: ___________________________________________________

Street Address:____________________________________________

City:_________________________ State:_______ Zip:_________

E-mail:__________________________________________________

Home Phone: __________________Work Phone:_________________

_____ $249 Early Registration (by August 1)

_____ $299 Regular Registration (after August 1)

_____ Returning Student (other special rate)

I found out about this seminar from: _________________________

I was referred by: ___________________________________________

I have referred: _________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________

Send the registration form and Check or Money Order to:

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