Transformation Breath Foundation
Personal & Professional Training Program
REGISTRATION FORM  

Name___________________________________________________

Address_________________________________________________

City__________________State____ Zip__________Country________

HomePh.______________________Cell_______________________

WorkPhone______________________Birthdate__________________

E-Mail__________________________________________________

Referred By______________________________________________

Cost of Training 

          Scholarships available.                                                                    Level I  $350, Level II  $350, Level III  $350, Level IV  $1200
Prepay Personal Program (Levels I, II, III) $945 Professional Program     (Levels I - IV) $2025  Level 5 $1200
  Couples rate is 15% off the individual level prices
*A deposit of $100 is required to reserve your place.  All deposits/payments are transferable to other dates but not refundable

Please enroll me in the Personal & Professional Training Program 
Level (circle all applicable):   I    II    III    IV    V    

Dates__________________________________________________

Location ________________________________________________

  Enclosed Check/Money Order #______________________________

Visa/MC/AmEx # #________________________________________

Exp. Date________  Name__________________________________

Signature________________________________________________ 

*Return this completed form with payment to:
Peter Murray, PO Box 212, Stuart, FL  34995 USA
1(772) 286-2643       info@breath2000.org