THE HIDDEN GIFT 1-DAY INTENSIVE

October 7, 2006
Orinda, California

SCHOLARSHIP APPLICATION / REGISTRATION FORM

Name: _________________________________

Phone: _________________________________

E-mail: _________________________________

Birthday: _______________________________

Address: ___________________________________________________________

What is your intention for this workshop? What do you want to get out of it?

Please initial that you understand and agree to the following statements:

____ I understand that if I register for the workshop and then don’t come, a $25 no-show fee
will be charged to my credit card. This deposit will not be charged if I attend. This event should
be sold out, and if I do not attend, it will be too late to give my spot away.

____ I understand that if I cancel my registration after August 26th, I will be charged a $10
administration fee. If I cancel before August 26th, I will not be charged anything.

____ I understand that I’m committing to be there for the entire day.

____ I understand that the workshop may be recorded. I give permission for myself to be recorded.

____ I understand that I must provide my credit card information below to reserve my spot at
the workshop. However, my credit card will not be billed unless I owe an administration fee or
no-show deposit as explained above.

CREDIT CARD INFORMATION:

Name as it appears on card: _________________________________

Billing Address: _________________________________

Number _________________________________
:
Expiration Date: _________________________________

CIV #: (3 digit # on back) _________________________________

Signature: _________________________________

Michael Educational Foundation, 10 Muth Drive, Orinda, CA 94563 ~ Phone: (707) 748-7715
Email: office@mef.to Website: www.mef.to