* * TO REGISTER * *

My check, money order (payable to Liana Carbón ISW Inc.)  in the amount of USD $ ___________ is enclosed.  Mail to: Institute of Shamanic Wisdom, Inc., 2135 Cecelia Terrace, San Diego CA  92110 USA.

Confirmation, additional information and directions sent upon receipt of registration. Early registration is highly encouraged.

Course Title ____________________________________________________

Dates of Event _____________________________________________________

Today’s Date ____________________________ Name ________________________________ Home Address __________________________ ____________________________________ City _________________________________ State/Prov _____________________________ Zip Code ______________________________ Country ______________________________

Company Name ___________________________ _____________________________________ Home Phone ___________________________ Mobile Phone ___________________________ Fax __________________________________ Email ________________________________ Website ______________________________

What is your reason for signing up for this course? ______________________________________________________________________

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How will this course help you with your business or life? ______________________________________________________________________

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If you could wave a magic wand and change three things in your life over the next 6 months, what would they be?

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What do you hope to learn at the end of the course?

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** RELEASE – All registrants must read and sign!**

• I understand there is a fee of $____________ in U.S. Dollars to participate in this Course.  This fee includes a $50 non-refundable deposit.
• Fourteen (14) days prior to the beginning of the Course the entire fee will become non-refundable. Tuition may be applied towards the cost of another workshop, retreat or journey.
• I understand that the Institute of Shamanic Wisdom, Inc., any individual, and/or any organization associated with the Institute of Shamanic Wisdom, Inc., is not responsible for, and I release them from liability for any loss or other mishaps that might occur, whether or not as a result of negligence, in connection with this Course.  I am fully responsible for my own experience.
• I understand that having an email address and access to a computer is helpful in order to download additional assignments,, receive important course information and participate in the Online discussions in a password-protected section of the Institute’s Shaman Circle Forum.
• I have read, understand and agree to this Release Statement and have answered all questions truthfully.

SIGNATURE:  ______________________________________________

Date: _____________________________________________________