Kundalini Yoga Teacher Training Level 1

Transformational Courses

Credit Card Payment Form

(To be used along with the Registration Form on brochure if paying by credit card)

Please print legibly:

Date: _____________________

Name: ________________________________________________________

Address: ______________________________________________________

City, State and Zip ______________________________________________

Phone ________________________Email ___________________________

For payment with Master or Visa card, please print this form, fill it in, sign it and

fax to 954-755-0247, OR mail to the address at the bottom of the page OR scan and email to deva@khalsa.com.

Card Type: ( ) Master ( ) Visa

Credit Card Number: _____________________________________________

Exp Date: _________________

Payment options:

(_________initial here) A. $400 registration fee to be charged to my card now.

$2,100 to be charged to my credit card on September 8^th, 2007.

(_________initial here) B. $400 registration fee to be charged to my credit card now.

$290 to be charged to my card on the date of our first class each month September 2007 through April 2008.

(_________initial here) C. $400 registration fee to be charged to my card now.

I will make $290 payments by check/cash on our first class of each month September 2007- April 2008.

I authorize Transformational Courses to charge my credit card as outlined in the payment plan option that I have initialed above:

Cardholder’s Name: ______________________________________________

Cardholder’s Signature: ___________________________________________

Transformational Courses ~ 1442 NW 100 Drive ~ Coral Springs, FL 33071 ~ 954-345-6006