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The Bangkok Seminar
Official Registration Form
Secure Online Payment:
Yes, John and Jeff - I'm ready for the most positive change I have ever made in my life. Sign me up for the Men's Edition of The Bangkok Seminar, January 14-18, 2008. I am absolutely ready to let go of my limiting beliefs and finally understand how to walk the earth as the demigod I was born to be. Thank you so much!
Fax or Mail Ordering:
Print and FAX this form to 1-480-247-4441
or mail to:
Jeffrey Richards
Peak Performance Hypnosis
5860 Riverton Rd.
Columbus, OH 43232
All credit card transactions will appear on your statement as charges to "Peak Performance Hypnosis."
___ Enclosed is my check or money order for $995.
___ Charge my: Visa, Mastercard, American Express, Discover (circle one)
Card Number: ______________________________________________
Security Code (the last three digits on the back of your card): ______________
Exp. Date: _____________________
Signature: __________________________________________
Print Name: __________________________________________
Address: __________________________________________
City: _____________________________ State: ________________
Zip/Postal Code: _______________ Country: __________________
Date of Birth: _____________________________________
Telephone: __________________________________________
Fax Number: __________________________________________
E-Mail: __________________________________________
Should you need to cancel your registration for any reason, the following policies apply:
- Cancelation prior to December 15: 90% refund
- Cancelation between December 15 and January 10: 50% refund
- Cancelation after January 10: no refund
- No refunds will be made for any reason until the funds for the original payment have been deposited in our bank.
- If you cancel after January 1, the non-refundable portion of your payment may be applied to a future seminar offered through this site. The seminar for which these funds are to be applied must be held within 24 months of the seminar for which you were originally registered. Should you cancel your registration to that future seminar, only the money paid at the time of the registration for the future seminar will be eligible for any refund, and the refund policies in place at that time will apply.
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