BASICS OF THETA HEALING with Brent Phillips SPECIAL VIP Club PRICING: $497 (save $500!

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Name _______________________________________________ Address _____________________________________________ City ___________________________ State ____ Zip ________ Email _________________________ Phone: _______________ A $200 non-refundable deposit is due to secure your space and your spot and extra-discounted rate for the seminar. You may pay by cash, credit, check, or money order. The balance is due by the first day of the class. __ I have enclosed a check or money order made to Theta Healing LA __ I have sent a PayPal for $200 to brent@thetahealingla.com __ I wish to pay by credit card: __ Mastercard __ Visa __ Discover Card Number: _____________________ _______ Expire Date (MM/YY): __________ CVV2 Number: _____ (the 3 digit code on the back) __ I prefer the credit card payment plan ($59.70 per month for 10 months) I authorize Theta Healing LA to charge my credit card for the amount of _____ Signature: _________________________ Dated: ______________ If this cards billing address is different from the one above, please enter it here: Billing Address ___________________________________________________ City ______________ State ____ Zip _______ Please mail this completed form, and attached check or money order (if applicable), to: Theta Healing LA; 5842 W 78th St; Los Angeles, CA 90045 OR fax to 424 832 3508 OR email to brent@thetahealingla.com I accept the refund and transfer policy below: (sign here) _________________________

If you complete the seminar and still have not seen a miracle happen after 6 months of practicing and trying at least one private session or practice group with Brent to heal your blocks, we will refund 110% of your money! If you can not attend the seminar and contact us at least 3 days in advance, you may transfer any Theta Healing LA Basics of Theta Healing seminar during the next year, free of charge. If you attend the seminar but are unable to complete it for any reason, you may make up the time you missed at any seminar in the next year, free of charge. If you can not attend the seminar and contact us at least 3 days in advance, you may transfer your payment and registration to another person, free of charge. If you do not notify us in advance and miss the seminar, the $200 deposit to secure your spot and extradiscounted rate is non-refundable. All seminar materials and free gifts must be returned to process a refund.