PLEASE PRINT ON WORKSHOP REGISTRATION FORM

NAME                                                                                                                 

ADDRESS                                                                                                          

CITY/STATE/ZIP                                                                                               

PHONE DAY                                                  EVE                                            

DATE OF BIRTH                                                                                             
                                       month                 day                year
TIME OF BIRTH                                                    Circle    AM         PM      

CIRCLE SOURCE OF BIRTH TIME:               BIRTH CERTIFICATE       OR    OTHER (Explain)

(Explain)                                                                                                               

CITY and STATE OF BIRTH                                                                           

E  MAIL ADDRESS  _______________________

SEND THIS FORM AND CHECK FOR $125 TO:
                   SIGNE QUINN TAFF, P.O. BOX 2457, SEDONA AZ. 86339

All applicants are advised and notified that Signe Quinn Taff will review the above application prior to acceptance.  Ms. Taff and her staff reserve the right to reject applications for any basis deemed appropriate by Signe Quinn Taff alone.  If the application is rejected, you will receive reimbursement for all checks attached to the application.  If your application is accepted, the form will act as the registration and you will receive a confirmation from Signe Quinn Taff.  No one will be allowed admittance without written acceptance and confirmation of the registration from Signe Quinn Taff.