Name: __________________________________________________

Address: ________________________________________________

Home Phone: __________________    Work Phone: _____________________

ENTER THE APPROPRIATE CLASS TUITION PAYMENT BELOW:

GRAND LONG FORM TAI CHI CHUAN & QIGONG, Level 1 Beginner:
  ____ Quarter 1,  Thursday Evenings    6:15 - 7:30 PM
          Payment Enclosed:   $ 185  Quarter 1 (DVD sold separately)

LONGEVITY  TAI CHI  &  QIGONG, Beginner Level:
  (Check class time below.)
  ____ Saturday Mornings,  9:00 - 10:15 AM
          Payment Enclosed:   $ 185  (DVD required course material, sold separately)

INTERNAL SYSTEMS Qigong:
          Payment Enclosed:   $  ______

Qigong FOR CANCER: 
          Payment Enclosed:   $  ______

Qigong FOR FERTILITY: 
          Payment Enclosed:   $  ______

Temple Qigong:
          Payment Enclosed:   $  ______

Qigong WORKSHOP:
          Payment Enclosed:   $  ______

OUTREACH PROGRAMS:
Site Location: ________________________________________

Date of Class: _______________________    Payment Enclosed: $________

Classes are not pro-rated. No Refunds.