The Magic of the Feminine - Registration Form

First Name   Middle Initial
Last Name
Street Address
 
City , State Zip Code
E-mail Address:
Phone --  Ext.
Credit Card Information: MasterCard / Visa
Card #: 
Expiration Date: 

Checks can be made payable and mailed to Cindy Suess, 5422 Hermitage Ave., #101, Valley Village, CA 91607. Or fax your credit card registration to 215-895-9822. Cost is $75. Your registration will be confirmed by email along with more fun-filled instructions and directions.

We are looking forward to creating magic with you!