Ariel & Shya Kane: Catalysts for Instantaneous Transformation
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Seminar Registration
& Balance Payments

Registering & paying your balance for courses is easy! Just follow the 3 STEPS below.

STEP 1: Enter Personal Information:

First Name and Last Name (required):
Name you prefer to be called:
Email (required): Address (required):
City (required): State(required):
Zip Code (required): Country:
Home Telephone (required): Work Telephone:
Cell Phone

STEP 2: Select Your Course(s):

At least one course is required when filling out this form

Instantaneous Transformation Monday Evenings & Special Evening Seminars

Please list names of additional participants you are registering for the course above:

Total number of participants for the course above:  
Details/Comments:

Weekend Courses & Costa Rican Adventure 2015

Please list names of additional participants for whom you are registering or paying balance:

Total number of participants for the course above:  
Please list names of additional participants for whom you are registering or paying balance:

Total number of participants for the course above:  
Details/Comments:


STEP 3: Enter Your Payment:

Amount paying: $

Check ** Money Order ** Wire Transfer
Visa Mastercard
Credit Card# - - -
Expiration Date (mm/yy)
CCV Code
Name on C.C.

Please enter your initials stating that you agree that the deposit portion of your tuition ($100 for weekend seminars, $75 for 1 day seminar, 1/3 for Costa Rica) is non refundable and non transferable. In addition, the full payment for evening seminars is non-refundable and non-transferable. (required) PLEASE NOTE: Balance for all weekend courses is due the Monday prior to the start of the course.

** For courses held in New York, please make checks payable to Ariel & Shya Kane, Inc.

For all other courses, please make checks payable to ASK Productions, Inc.

Please mail checks to:

Ariel & Shya Kane Inc.
C/O Joshua Blau, CPA
1180 Avenue of Americas
Suite 836
New York, NY 10036