Workshop Special Registration Form

Please Print Twice. Each Participant Must Complete and Return This Form.
Name:
Address:
City:
State:
Zip:
Phone 1:
Phone 2:
Email:

Date Of Seminar:

Vegetarian Meal? ( Y / N )

Any Other Dietary Restrictions? ( Y / N) Describe:

Method of Payment
PayPal - Check or MO - Credit Card

Make Check or MO out to:
"Humanus Magnificus"

Card #:
Name On The Card:
Expiration Date:

Send Payments To:

Humanus Magnificus
PO Box 1353
Winter Park FL 32790-1353
Fax 407-644-6829

Cancellation And Payment Policies

4-Hour Workshops
You may cancel in writing up to two weeks prior to the workshop date to receive a refund. There will be a $15.00 administration fee assessed for canceling. After two weeks prior to workshop there are NO REFUNDS.

Chateau Experience
You must be paid in full 90 days prior to the departure date. There is a $100 administration fee for canceling once your deposit of $500.00 is made toward your trip. If you cancel after the 90 day paid in full date there are NO REFUNDS AVAILABLE. Traveler substitution is subject to a $200 penalty.

Our workshops are educational experiences, and are not to be mistaken for long-term therapy or cure. Some people may find some programs to be too psychologically or physically challenging. We recommend that in case of any doubt, a physician or trusted counselor be consulted.

Signature:

Date: