The Academy of Human Universal Energy and Spirituality

REGISTRATION FORM Level 20.1 Seminar From 13th to 17th August 2008 Melbourne, Australia

1.Full name: ________________ ___________________________

              (first name)	(family name)

2.Names preferred to be on certificate: _________________________________

3.Gender: Male / Female (please circle)

4.Date of birth: ____/____/19__

5.Place of birth: _________________ , ________________________

6.Citizenship: ________________________

7.Occupation: ________________________

8.Contact details:

Postal address: ____________________________________________

City: __________________________ Postcode: _____________

Country: ___________________________

Email address: _____________________________

Tel.: ( ) _____________________ Fax: ( ) _____________________

9.Level 20’s details:

Dates attended Level 20: ____/____/200_ Place of attendance: ____________________

ACKNOWLEDGEMENT I hereby acknowledge that no representation in whatsoever form - verbal, written, explicit nor implicit promise - has been made to me to guarantee that my participation in LEVEL 20.1 SEMINAR organized by HUESA would guarantee me to apply successfully the instructions in the said seminar to cure/heal illnesses. I further acknowledge that the mere obtaining of Certificate of Attendance in this Seminar does not imply any guarantee of success in the treatment of any person’s illnesses nor approval of registration for higher level seminar/s. I understand that the seminar costs paid to HUESA for this Level 20.1 Seminar are not income tax deductible.

			_____________________  dated            /            / 2008  
				(place)


				__________________________ (signature)