PLEASE PRINT 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
CHOOSE ONE: the BIRTHDAY closest to the Workshop

• WHERE YOU WERE ON YOUR MOST RECENT BIRTHDAY
• City/State ___________

OR

WHERE YOU'LL BE ON YOUR UPCOMING BIRTHDAY

• City/State _________________

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.