ENROLLMENT FORM FOR PLAYERS' EROTIC DOMINANCE INTENSIVES

Please do NOT send this enrollment form and registration fee unless you have already returned the Application Questionnaire and have had a phone conversation with Cléo Dubois, during which we have both decided that the course is right for you. Please send to:

Cléo Dubois Academy
Post Office Box 2345, Menlo Park, California 94026-2345

ENROLLMENT AGREEMENT
For Applicant Below

Student Name ________________________________________________________________________

Partner’s name if applicable _____________________________________________________________

Postal Address ________________________________________________________________________

City _________________________________ State_________ Zip__________ Country______________

Home Phone _____________________________ Cell Phone ___________________________________

Partner’s phone if applicable ___________________________________

Best Time to Call ___________________________________________

Email Address ______________________________________________

Partner’s email if applicable ___________________________________

This agreement is a legally binding instrument when signed by the student and accepted by the Academy of SM Arts. Your signature on this agreement acknowledges that you have been given reasonable time to read and understand it and that you have been given a description of the course of instruction and materials provided, and have read and are aware of the refund policies stated below.

This Agreement is for the following course:

This Agreement is for the following course (check and complete one below):

____ The Men's Intensive Weekend (Total Cost $600 single, $750 couple)

____ The Women's Intensive Weekend (Total Cost $600 single, $750 couple)

For Course Starting on: ________________________ Completed on: __________________________

Send a $200 deposit with this application to reserve your space. Please make check payable to Cléo Dubois Academy, if mailing a check. Balance due at the start of the course.

WORKSHOP FEES & CHARGES: The total cost is $600  single, $750 couple, which includes a non-refundable Registration Fee of $100.

REFUND POLICY: The Student has a right to cancel this Enrollment Agreement and obtain a refund by providing written notice to the Academy of SM Arts. A deposit refund, less the $100 non-refundable Registration Fee, will be granted if a cancellation notice is given at least 14 days prior to the course start date.

STUDENT SIGNATURE:____________________________________________ DATE:_________________


ACCEPTED BY THE ACADEMY: _____________________________________ DATE:_________________


DEPOSIT ENCLOSED: $ ___________ Check _____ Money Order _____ Paid by Credit Card _____

Please copy and paste this into a word processing program (or click here to download an MS Word document). THEN COMPLETE, SIGN & RETURN THIS AGREEMENT WITH YOUR DEPOSIT TO:
Cléo Dubois Academy, P.O. Box 2345, Menlo Park, CA 94026-2345

Please make check payable to Cleo Dubois Academy.

PAY ONLINE: