Enter your name exactly as you want it printed on your certificate, including initials (PhD, LISW, etc.):

Please list the class level(s) you are registering for:
Level 1 Date/location:
Level 2 Date/location:
Level 3 Date/location:

Contact Information:
Address Line 1:
City and State:
Zipcode:
Country (if outside US): [text*country]
Home Phone:
Office Phone:
Cell phone:
Email:

Healing Practice:
Type of healing practice you have:

Payment Information:
Eligible for Earlybird or Extra-earlybird rate?
(if not eligible for the early bird or extra early bird rates, do not check this box.)

Type of payment:
Paypal*Personal Check or Money Order

*Return to the course page for Paypal buttons to submit payment, or send Paypal payments to Dr. Stone’s account at contact@souldetective.net

Checks/Money Orders can be sent to:
Barbara Stone, PhD
1817 State Route 83, Unit 513
Millersburg, OH 44654