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Home Study Course Advance Payment Form
and/or
Appointment Schedule
Name:___________________________________________________________
Address: _________________________________________________________
(Mailing Address/Street
________________________________________________________________
Please include City/State and Zip Code)
Phone: ( ) __________________ Other: ( ) ______________________
e-mail (if any) ________________________________________________
Occupation (Optional) ___________________________________________
Gender: M ( ) F ( ) Age: __________
Please give a day, month and time (AM or PM) that would be convenient
to schedule your Ear Coning sessions 2 - 4 WEEKS apart.
Month: ______________________
Day: ________________________, 2010
BY APPOINTMENT ONLY
Monday - Saturday or Sunday
At your convenience between 9AM - 6PM
Tuesday thru Friday: Between 3:30PM and 5:30PM only
@ 3430 W. 43rd Street, Los Angeles, CA. (Upstairs)
(323) 481-9007
Please call you to confirm or assist you with scheduling.
Doris J. Garrett
Certified Holistic Practitioner
P.O. Box 36417
Los Angeles, CA. 90036
California resident for over 50 years
in Los Angeles/Wilshire district
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