Discovering What You Really Know

Class Registration Form

Registrant Name:

Date of Birth:

Address:

Phone (best phone number to reach you in case of cancellation):

Email address:

Do you consider yourself to be an Indigo? Yes/No

To better serve the needs of the class, please briefly describe yourself and what you are currently experiencing:

The cost for this series of classes is: $200.

This information may be printed and sent to Mica or emailed .

Mica M. Renes, N.D.
106 Wellington Place,
Cincinnati, OH 45219
Phone (513) 665-9015
Email: mica@micarenes.com