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Contact Information
First Name *
Last Name *
Email *
Phone Number *
Street Address *
City *
State *
Postal Code *
The name on your Certificate:
Check all that apply:  1-Year Clairvoyant Program
 2-Year Clairvoyant Program
 Online Clairvoyant Program
 Novice Spiritual Midwife Program (for CV students)
 Graduate Spiritual Midwife Program
 Hands on Healing
 One to One
 One to One Mentors
 Ministers in Training (MITS)
 Teacher's Program (BPIT)
 Licensed Minister
 3-Year Trance Medium
 Trance Medium Teachers
Billing Address
Street Address 1 *
Street Address 2
City *
State *
Postal Code *
Credit Card Information
Card Type *
Card Number *
Expiration Month *
Expiration Year *
Start Month (if avail)
Start Date Year (if avail)
Maestro Issue Number (if avail)
Product Purchase Plan
CDM Graduation CertificateAmt
Total amount of $30.00 charged today,
1 Payment of $0.00 remaining.
Total Amount You Pay Right Now
If you are graduating from more than 1 program, please fill out the form again. Thank you!

For questions, please contact
Church of Divine Man Administration
Phone: 510-847-9206
Mon-Fri, 10 AM - 5 PM PST