Please provide the following contact information:

Name
Street Address
Address (cont.)
City
State
Zip Code
Work Phone
Home Phone
Cell Phone
E-mail
Certification or Training?	Please place an X in the appropriate boxes:
Please register me for the program beginning in January 2008	Sign me up!
PAYMENT METHOD: ($250.00) NEWLIFE P.O. BOX 210763 DALLAS, TX 75211-0763	I will be mailing in the full          payment now. I want to pay in installments          starting now. I want to start paying when          I start the course.
Please contact me by phone