Tabacon Partners
535 South Shore Center, ste#130,
Alameda, CA 94501
Fax: 510-217-4406

Membership Order Form

You can use this order form to fax your credit card information or attach/mail a check. Please print out this web page and complete the information below and fax with credit card information (see fax # on top of page) or attach with check and mail to the address on the top of this page. Once we receive the fax or payment in the mail, we will email you a confirmation and our Membership Welcoming Kit . If you have any further payment questions, please call 510-388-5969.


School Information

Contact name _____________________

Contact telephone _____________________

Contact email _____________________


Payment Information

___ Yes, I’m paying by check. I’ll enclose a copy of this order form and check and mail to: Healing-Schools / Tabacon Partners, 535 South Shore Center, ste# 130, Alameda, CA 94501

___ Yes, I’m faxing my credit card information. Fax # is 510-217-4406

Credit Card Payment Information: (please fill in each line for correct processing)

Card holder name (as it appears on card) ________________________

Type of card: (Visa, Mastercard, etc.) ________________________

Card #: ________________________

Expiration date: (month/year) _____

Three digit # on back of card: _____

Cardholder Address: ________________________  
                                      ________________________

Membership Type:

____ Regular -- $195 (see rates for first time members)

____ Premium -- $275 (see rates for first time members)