To enroll in Mastering Personal Creativity, please print this form, fill it out, and mail or fax it to:
Spiritsmith Company
3857 Birch Street, Suite 288
Newport Beach, CA 92660-2660

FAX: 949-759-5432

Name __________________________________________________________________

Address __________________________________________________________________

__________________________________________________________________

__________________________________________________________________

Telephone __________________________________________________________________

E-mail address __________________________________________________________________

Credit card number and expiration date

________________________________________________________________________________

Credit card billing address, if different.

__________________________________________________________________

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Note: If you need to purchase a copy of Take a Moment and Create Your Life!, please add $13.93 (the cost of the book and shipping) to your check or credit card amount.

Please check one.

_____ I have included a check for $300 to cover my Mastering Personal Creativity tuition.

_____ I have included a check for $313.93 to cover my Mastering Personal Creativity tuition and book.

_____ Please bill my credit care $300 to cover my Mastering Personal Creativity tuition.

_____ Please bill my credit care $313.93 to cover my Mastering Personal Creativity tuition and book.

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