APPLICATION FOR LESSONS

Print this form from your computer to fill it out. Then to receive the Lessons available through the Guild, please complete the following:

NAME: _______________________________________________________________________

ADDRESS: (Street)___________________________________(City)______________________

(State)____________________(Country)___________________ (Post/Zip Code)____________

TELEPHONE: (Home) (_______)_________________ (Work) (_______)__________________

FACSIMILE: (_______)___________________ Email:_________________________________

URL: __________________________________________

Please fill the section below that applies to you:

[__] I am already an Initiated Member of the Network:

[__] I enclose A$10.00 for the first Lesson.

[__] I wish to order a copy of the Mantra Meditation Tape & enclose A$18.00 for this.
[__] I enclose A$10.00 for the first Lesson.

[__] I wish to order a copy of the Mantra Meditation Tape & enclose A$18.00 for this.
[__] I have filled in the Membership Application Form and sent it with this form.
[__] I enclose A$10.00 for the first Lesson.

The total amount I have enclosed is A$______.00

I am paying by (indicate which):

[__] A Bank Cheque, [__] Money Order, [__] International Bank Draft, [__] Credit Card Authority

Payment by cheque, money order, or bank draft must be in Australian dollars and made payable to Biame Network Inc. Personal cheques drawn on non-Australian banks are not accepted.

CREDIT CARD AUTHORITY
My credit card is :

[__] MasterCard, [__] Visa, [__] Bankcard (Australian/NZ),
[__] Diners Club, [__] American Express

Credit Card Number:

N.B.: You can make your Membership Fee and/or Training Fee payments automatically each year by credit card. To do this, fill in the Automatic Fee Payment Form. You save A$5.00 per fee by doing this..