Registration for Fire Serpent Tantra Kundalini Mystery School. 
	www.fire-serpent.com
	
	1.) Open this form in a text editor such as Notepad. (Or copy-paste into notepad)
	2.) *type in* your information
	3.) print a paper copy.
	4.) put it in the envelope and mail it with your payment. 
	5.) Paste a copy into an email and send it to Mystress (at) fire-serpent.com 
	
		
Your name: 

Address: 

City:   

Region:   

Country:    

Code: 

Telephone: 
   
Email: 

Username:
   
Password: 

(Username and password are case sensitive.
 No spaces, punctuation or special characters.
 Letters and numbers only. 
 Must be more than 4 digits in length)

Check one:

____ $150.CDN Tuition for a one year membership to Fire Serpent Tantra Level 1. 


____ $180.CDN One year membership plus FST CD. 


Today's Date:                                             

Your comments: 







 Your Signature: 







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Mail your payment to: 

    Angelique Serpent.
    74624- 2768 West Broadway. 
    Kitsilano RPO. 
    Vancouver, B.C. Canada
    V6K 4P4

   If you are intending to send payment by courier package, please contact me for an alternate address. 

   Many students are from countries where it is difficult to get US or Canadian currency. I can accept checks in foreign currencies and exchange it here, but there is on average an 8% fee charged by the currency broker. Calculate the exact current exchange rate, then add 8% for conversion fees.  

   My bank holds all non-Canadian checks for three weeks, and snail mail is slow. Allow (+-) one month for your membership to be activated.