PHONE: (510) 883-9932 • EMAIL: LAELGOLD@GMAIL.COM • PRODUCTIVESLUMBER.COM

DREAMS AND DREAMING CLASS ENROLLMENT FORM

Name:

Primary phone number:

Primary email:

Information to share with Lael, if any, regarding learning challenges, special requirements

or anything else:

__  My payment is enclosed.

__  I paid online via Paypal.

__  I understand that all fees paid are non-refundable.

Signed and Agreed:

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To save a spot in the class, complete this form and mail it together with your check (or after completing online Paypal transaction) to:

Lael Gold, Ph.D.

PO Box 5801

Berkeley, CA 94705