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| NAME ___________________________ADDRESS_____________________________ |
| CITY _________________________________STATE ________________ ZIP _______ |
| Renewal of Old Membership [ ] | Life Membership [ ] | New member [ ] |
| Please enroll me as a member of the ESP Laboratory. I understand that this entitles me to the Monthly Newsletter, and the Placing of my Name on your Prayer list for thr Green, Blue and White Light. |
| Member's dues : | |
| ________ months @ $ 2 / month ( $3 / month outside North America ) | $ _________ |
| ________ Family members at $ 1 each / month | $ _________ |
| ________ Family pets - group at $ 1 each / month | $ _________ |
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Please enter the following names on the prayer list for the GREEN LIGHT of Prosperity : __________________________________________________________ |
$ _________ |
| Please enter the following names on the prayer list for the BLUE LIGHT of Healing : __________________________________________________________ | $ _________ |
| Please enter the following names on the prayer list for the WHITE LIGHT of Spiritual Growth : __________________________________________________________ | $ _________ |
| Please enter the following names on the ALTER OF DIVINE COMPANIONSHIP ; |
| [ ] attract perfect mate | [ ] friendship | [ ] promote marital bliss | ____ names at $ 1 each | $ ________ |
| ______ Questions for the ALTAR of PSYCHIC CONTACT | $ ________ |
| Intensive Teatment $ 50 / month or $ 25 / 2 weeks, or any personal service by Al Manning & TexLab Spirit Band |
| For : _______________ Problem : ________________ Period___________ at | $ ________ |
| EXTRA HELP : I would like to donate extra to help further you work $ ________ |
| SEED MONEY FOR : ______________________________________ $ _______ |
| Total Donation Enclosed $ ______ |
| PLEASE SEND ME : |
| [] ESP LAB Catalogue | [] Membership Info to Astral Lab | [] Membership Info to Astral Coven | [] Lottery Program |
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| ESP LAB : I suggest that you send our introductory literature to the people whose names and addresses I have entered below. |
| Name ________________________ Address_________________________________ |
| City ____________________ State _________________ Zip _________________ |
| Name ________________________ Address_________________________________ |
| City ____________________ State _________________ Zip _________________ |