| Registration
Please print this form and fax or mail to the address above. |
Name__________________________________________________________________________ |
Address________________________________________________________________________ |
Phone# Day
_________________________Evening____________________________________
|
Business
Name__________________________________________________________________ |
Please indicate order of preference for workshop and workshop dates.
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| 1. Workshop_____________________________Date_________________________ |
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| 2. Workshop_____________________________Date_________________________ |
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A
$200 non-refundable deposit must accompany this registration
Your registration fee includes:
-
Instruction, written materials, &
hands-on experience
Certificate of completion 5% Discount for students
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Credit Card Payment Information
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Name
|
Phone
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Address
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Zip |
Country |
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Amount |
Signature |
| Card
Number
3-digit code (back of card)
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Expiration
Date
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Please help us get to know you by taking a moment to complete our
clinic survey. Thank you. |
- Are you a massage therapist?
yes____ no____
- Have you had courses in massage or related fields?
- If Yes, where and when?
- Do you currently work with animals?
- Will you use this clinic information in your business?
- You will bring your animal.
yes____ no____
- You can be contacted at __________________day
_________________night.
- You need additional lodging information.
yes____ no____
- Are you over 18?
yes____ no____ Male or
Female
- Where did you hear about our
clinics?_________________
- On a a separate page, please include a few words about yourself.
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