Synergy in Sedona:  March 7 & 8, 2009
ADVANCE REGISTRATION FORM -  Valid to Thursday, March 5 at 5 PM

PRINT and MAIL this Form (with your check) to: Dr. Chet Snow,
PO Box 1738
, Sedona, AZ 86339
or FAX to: (928) 204-1955

Please, make all checks payable to: Dr. Chet Snow.

Name(s):_______________________________________________________________________________

Address: _______________________________________________________________________________

City/State/Zip: _________________________________________________________________________

Phone: (________) ___________________  Fax: (________) __________________

E-mail address: ________________________________________________________________________

_____     I want an appointment for a Private Session with Synergy  in Sedona @ $60 each.
         Appointments are for 1 person only.  Please send a separate registration form per session.
All appointments are in Sedona and on either Saturday or Sunday: March 7 & 8, in the daytime. 

$______ TOTAL AMOUNT, either by enclosed Check or by Credit Card 

To reserve today: print this form and fill in the Credit Card data.   Fax the form to: (928) 204-1955.

Visa: _____ MasterCard: ______ Discover: ______  [No Am Exp. - or go online & pay via Pay Pal]

Card Number: ____________   ____________   _____________   ______________

Expiration Date: _______________Signature:_____________________________

ALL Registrations must include your Phone Number so we can contact you about Session Time & Place
The Session Times and Place will NOT be announced to the public.  No Public Viewing or Sessions.

A $10 administrative fee will be taken from EACH cancellation.  
NO Refunds given for cancellations after February 20, 2009
For additional details, call Dr. Chet Snow: (928) 204-1962.

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