Register
1. Silva Life System Seminar
(Application Form
)
2. Silva Intuition System Seminar
(Application Form
)
Silva Grad Certificate Number
Name:
*
Address:
*
City:
*
State:
*
Z
ip:
-
*
Date of Birth:
Day
Month
Y
ear
Phone : Home
*
Phone : Cell
Phone : Work
e-Mail:
*
Profession:
Dates you wish to attend
*
*
required
How did you learn about the Silva Method?
Friends/Family
Newspaper
Other Publications
Book
Tape Series
Other
Check any or all benefits you'd most like to gain from the Silva Method Course
Learn to relax
Set and achieve goals
Learn creative problem solving
Improve health
Salesmanship
Find your life's work
Overcome insomnia
Stop headaches
Develop a positive attitude
Reduce stress
Find your soulmate
Improve memory and concentration
Reduce weight
Eliminate non-productive habits
Change limiting beliefs
Stop smoking
Free yourself from worry
Improve personal relationships
Develop confidence
Create prosperity
Awaken intuition & creativity
Have you been treated for :
Mental Disorder
Seizure Disorder
Fainting Spells
If you are or have ever been under a doctor's care for the above conditions, you can attend the seminar
ONLY
with the express written permission of your doctor.
Once you've decided to attend press the submit
button above. Next
,
print the form using the"print" button on your browser and mail it to me with payment to the address below, or make payment through PayPal, to SilvaMehtodNJ@verizon.net. Keep in mind that I have to reserve the presentation space with sufficient advance notice, one year, therefore your committment to your attendance is important. Thank you very much.
Mail Payment to:
Alice M. Konyves, CSMI, CI, ACH
671 Ward Avenue
Westwood, New Jersey 07675
201 664-0118
Copyright 2004, Alice Konyves, All Rights Reserved
