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This form was designed to handle six students at a time.  For more than six students, just submit the form more than once.

If a student has taken more than one class (same or different weekends), just fill in their first and last name anytime after filling in the full information (address, etc) for the Basic class (e.g the first time you send in the information). 

A suggestion is to also print the confirmation screen (that comes up after you hit "submit" below), for your own records.

Note: if you have your browser (such as Internet Explorer) set up for the "auto fill" feature, it will try and fill in the form for you - you may want to go into "auto fill" and turn it off before filling out this form.

NOTE: WE DO NOT KEEP A RECORD OF STUDENTS WHO ATTEND HEALING ANGELS CLASSES.  WE ONLY KEEP TRACK OF IET STUDENTS.  THUS, YOU DO NOT NEED TO SEND LISTS OF STUDENTS FROM HEALING ANGELS CLASSES.  THANKS!

Name of Instructor:

Your Email Address:

Level of Class:

(note: If you choose "All 3 Classes" you must still give the dates for all three classes, separated by commas)

Date of class:             

Location of class:

 

Name of Student 1:

Address of Student 1 (apt, street):

Address of Student 1 (city, state, zipcode):

Country of Student 1: 

Phone number of Student 1 (incl area code):

Email address of Student 1 (if they have one):

 

Name of Student 2:

Address of Student 2 (apt, street):

Address of Student 2 (city, state, zipcode):

Country of Student 2: 

Phone number of Student 2 (incl area code):

Email address of Student 2 (if they have one):

 

Name of Student 3:

Address of Student 3 (apt, street):

Address of Student 3 (city, state, zipcode):

Country of Student 3: 

Phone number of Student 3 (incl area code):

Email address of Student 3 (if they have one):

 

Name of Student 4:

Address of Student 4 (apt, street):

Address of Student 4 (city, state, zipcode):

Country of Student 4: 

Phone number of Student 4 (incl area code):

Email address of Student 4 (if they have one):

 

Name of Student 5:

Address of Student 5 (apt, street):

Address of Student 5 (city, state, zipcode):

Country of Student 5: 

Phone number of Student 5 (incl area code):

Email address of Student 5 (if they have one):

 

Name of Student 6:

Address of Student 6 (apt, street):

Address of Student 6 (city, state, zipcode):

Country of Student 6: 

Phone number of Student 6 (incl area code):

Email address of Student 6 (if they have one):

 

Check this box if you will be sending additional student names for this class:

 

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Last modified: February 26, 2010