Primordial Sound Meditation Order Form

Tuition Schedule
Adults/$265 - Seniors/$225
Full-time Students/$225
Young adults age 10-18/$135
*Children ages 5-9/$55
Partial Scholarship Available Upon Request
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Free Introductory Lectures
Individual & Group Instruction
*The length and content of the children's course is modified for a shorter attention span and to capture the interest of this age group.

Yes! Please register me for the Primordial Sound Meditation Course!

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Name

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Address

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City State Zip

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Phone (h) (w)

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e-mail address

*Mantra Information

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Date of Birth (mo/day/yr) Please spell the month

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Place of birth (city/state/country)

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Time of birth (am/pm)
*Mantra data must be completed at the time of application & no less than 7 days in advance of the Course.

Please indicate the beginning date of the
Course for which you are registering:

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For Course dates & Continuing Ed schedule, please refer to the web site schedule, or call 402-330-2474.

Cancellation Policy - Cancellations are refundable minus a $95 administration fee. Cancellations made less than 24 hours prior to the Course dates are not refundable; however, the tuition paid may be applied toward a future Course. Non-attendance is not refundable.

Please make your check payable, and return it with this form, to:

Donna Miesbach
2805 S. 161 Plaza
Omaha, NE 68130-1802
402-330-2474 ~ dmiesbach@cox.net

~To teach, To heal, To love, To bless~