Prophetess Julia Currence Print Form
Name: _______________________________________________ Address: ______________________________________________ City: ______________________ State: __________ Zip: _________ Home Phone: __________________ Cell: _____________________ Organization: _________________________________________ Title: ___________________ E-mail: _______________________ Amount Enclosed: ______________________ Please list additional attendees:_____________________________________________________ NOTE: All fees are non-refundable and non-transferable. On-site registration for sessions is $60.00 per person and children $10.00 Please send to: Julia Currence |