Remote Viewing Registration Form

SecondSight Technologies
19/289 Harcourt Street,
New Farm,
Queensland 4005,

To register for the SecondSight Technologies Remote Viewing online course via mail, please print and complete this registration form.

Please mail the completed registration form along with your check/cheque or foreign draft for £59.99 in English sterling to the address at the top of this form. Please make your check payable to "Lee Heather" .

We'll send your training site login information via email within 48 hours of receiving your registration form, and you can get started.

Please be sure that all information contained below is legible.

Full Name: _______________________________________________

Phone Number: _________________

Email Address: ______________________________________________

Street Address 1: ___________________________________________

Street Address 2: ___________________________________________

City: _____________________ State/Province/county: _________________

ZIP/Postal Code: ______________ Country: ____________________

Signature: __________________________________________________

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