The Power To Speak Your Truth Registration Form 

Name: _______________________________ Street Address: _____________________________

City: ________________________________  State: _______ Zip: __________________________

Home Phone: (____)______-_____________  Email: _____________________________________

q       Cash/Money order

q       Check No*: _______

q       Visa.

q       Master card

q       American Express

q   Discover

CC #: ________________________________ Exp Date: ___ / ___ / ___  

Signature: _____________________________

* Make checks payable to The Kundalini Yoga Center