Registration for Mentoring and Leadership

Circle- 2017-2018

Full Name: ______

Mailing Address: ______

Contact Phone: ______Email: ______

This is a tuition-based course- all classes are required attendance. Costs of Mentoring and Leadership Circle are:

v  Full class tuition for 4 quarterly weekend classes held Fri. evening 7:00- 9:00 PM, and all-day Saturday & Sundays 10:00 AM-5:00 PM at Seattle University. / $1900.

Payment options available: Please circle one

Total Costs
v  Pay in Full by August 1st for a 5% discount of $95. / $1805.
v  Pay Total Amount in 10 monthly payments of $180. (after $150 deposit) between Oct-July / $1950.

**Please send in your $150 Deposit by Aug. 1st to ensure your placement**

Payment option details:

Payment option details:

Credit Card: To pay by credit card please fill out the Sundust Oracle Institute’s Credit Card Payment Authorization Form Below and submit that completed form with your class registration

Checks or Money orders: Please make checks or money orders payable to Sundust Oracle Institute

**Please note our refund and student account policies**:

·  25% Refund (only on paid-in-full accounts) if withdrawing within 30 days from class start date

·  0% Refund if withdrawing after 30 days from class start date

·  Deposit is non-refundable

**This includes all monthly payment plans—please see Payment Plan Agreement form below

**There will be a $35 fee for each individual returned check

**Any account balance over 90 days past due will be subject to collections

Please either email or mail this completed registration form in with your payment to Sundust Oracle Institute:

Email:

Mail to: Sundust Oracle Institute, PO Box 30125, Seattle, WA 98103

______

PAYMENT PLAN AGREEMENT

MY SIGNATURE BELOW CERTIFIES THAT I UNDERSTAND AND AGREE THAT:

• I am fully responsible for full payment of all tuition and fees by the indicated due date regardless of whether or not I withdraw from the class after 30 days of class start date. Failure to attend and complete class(es), workshops, and retreats does not diminish my responsibility to make payment to Sundust Oracle Institute by the due date.

• It is my responsibility to provide all necessary information to Sundust Oracle Institute in a timely manner in order to ensure that payment is received by Sundust Oracle Institute by the due date.

• If I fail to make payment as agreed, I may not be allowed to use this payment plan in the future and Sundust Oracle Institute is authorized to charge the credit card below for the amount due. I further authorize Sundust Oracle Institute to charge and collect a 2.5% fee when processing this credit card payment.

• If I fail to make payment as agreed and my credit card authorization does not successfully pay the balance owed, I will be charged a $100 collection fee. Thereafter, my account will be subject to standard collection actions and charges for delinquent accounts at Sundust Oracle Institute.

I, the undersigned participant, hereby apply for enrollment in Sundust Oracle Institute’s 10-month payment plan and am including the $150. non-refundable deposit fee with this form. My signature below confirms my understanding that this service is offered by Sundust Oracle Institute as an optional payment method and that I will be required to make timely payment in accordance with plan’s due date. I understand that if I fail to make payment as scheduled I will be liable for all costs Sundust Oracle Institute incurs in collecting the balance, including reasonable attorney fees, collection costs and finance charges. Further, I understand that this is a temporary extension of credit and constitutes an educational loan with Sundust Oracle Institute that may not be discharged under the provisions of federal bankruptcy law (specifically, the U.S. Bankruptcy Code, as it may be amended from time to time).

Student’s Signature Date

______

Sundust Oracle Institute

Credit Card Payment Authorization Form

To pay by credit card, please complete all sections below.

CREDIT CARD HOLDER INFORMATION

Please check credit card type:

Visa Master Card Discover American Express

Credit Card number: ______Expiration date: _____/______(mm/yy)

Name as it appears on card: ______CVV Code on back of card: ______

Billing Street Address: ______

Billing City: ______Billing State: ______Billing Zip Code: ______

Phone number: ______Email: ______

Payment to go toward (which SOI class/workshop/event):______

I, ______, hereby authorize Sundust Oracle Institute,

to charge my credit card account:

______Amount to be charged: $ ______(One time charge)

______Auto Pay/Monthly Recurring Payment Amount: $ ______

(Sundust Oracle Institute will charge your card on the 1st of Every Month)

Cardholder Signature: ______Date: ______

Hold Harmless Agreement

I______(print your name) agree to release, indemnify, and hold harmless Char Sundust and the Sundust Oracle Institute from and against any loss, damage or liability, including attorneys’ fees and expenses incurred by the latter entities and their respective employees, agents, volunteers, or other representative, arising out of or in any manner related to the activities of the Sundust Oracle Institute

Signature:______

Date:______

Sundust Oracle Institute (206)440-8886

PO Box 30125

Seattle WA 98103