Women: Lunar Being 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