UNDERSTANDING SPIRITUAL AND MENTAL HEALTH SEMINAR
by Divaldo P. Franco,
 March 12, 2004

              Registration Form

NAME:_____________________________________________________________

ADDRESS:__________________________________________________________
__________________________________________________________

PHONE: ___________________________________________________________
                               
E-MAIL: ___________________________________________________________

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Please kindly answer the following questions that will enable us to serve you better in
the future:

1. Are you associated with any Spiritual Organization?
□ No
□ Yes. Please, provide the name of the Organization_____________________
____________________________________________________________
       
2. How did you hear about this event?
□ Friend
□ Internet (e-mail, website, etc)
□ Newspaper
□ Other. Please specify: ____________________________________________

3.  □Yes, I want to receive e-mails from
The Spiritist Society of  Baltimore about
upcoming spiritual events.

Print and mail this form with a $ 10.00 check payable to Spiritist  Society of Baltimore to the
following address:

Spiritist Society of Baltimore, Inc.
               1101 North Calvert Street  # 514
                      Baltimore,  MD – 21202