Payment Plan A: $650 for first month, $150 per month for next 4months
Payment Plan B: $250 per month for 5 months
Payment Plan C: $350 for first month, $150 per month for next 6 months
Payment Plan D: Discuss a personal payment plan
Payment Plan E: Payment in full

Print this form, complete it, and fax to: 216-932-2968  or mail to: 
Tian Enterprises, Inc., 2188 Vernon Rd., University Hts, OH 44118
                   
Credit card payment information must accompany fax registration
Credit card or check must accompany mailed form

                         I would like join the course (check one or both)

    [  ] Certified Qi Healer Correspondence Training Course
    [  ] Certified Qigong Instructor Correspondence Training Course

                   and choose Payment Plan A B C D E (circle one)


Name________________________________________________

Address______________________________________________

City/State/ZIP__________________________________________

Phone_______________________________Date_____________

E-mail address ________________________________________

CREDIT CARD PAYMENT INFORMATION

Visa #_______________________________________________

Mastercard#__________________________________________

Expiration date________________________________________

Name on card_________________________________________

Signature____________________________Date_____________