Registration Form with PayPal Registration Form - PayPal Class Registration FormName First Last PhoneEmail Address Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Payment Information A $50 deposit is required to reserve space for each course. Full Payment is due by 1st day of class. Please fill in the total amounts due for all courses or program below.Please list the NAME and DATES OF CLASSES being registeredTotal Amount DuePayment Amount via PayPal Please enter your payment amount in the field and you will be directed to PayPal to complete the payment after clicking Submit.I accept all registration policies and approve any applicable credit charges. Submission of this card is considered a formal registration and indicates my agreement to all Polarity Healing Arts of California policies and conditions, including responsibility for all tuition incurred. I understand the right to cancel and refund statement below. Students have the right to cancel and obtain a refund of charges. Any cancellation must be given in writing either in person or by mail. Students shall be given until midnight following the first day of instruction to withdraw from a course and to receive a refund of all tuition paid less a $50 deposit. Refunds for cancellation after that period are based on a pro rata calculation. Students will be charged for the hours of instruction received up to the date the student formally cancels his/her enrollment. Any refunds due will be made within thirty (30) days of the formal cancellation date. Refunds are based on the following formulas and on advanced payment in full, each less the $50 deposit. 10% Hours of Instruction=90% Refund; 25% Hours of Instruction=75% Refund; 50% Hours of Instruction=50% Refund?60% Hours of Instruction=40% Refund; 75% Hours of Instruction=25% Refund; 100% Hours of Instruction=No Refund SignatureDate This iframe contains the logic required to handle Ajax powered Gravity Forms.