| Registration
Please print this form and fax or mail to the address above. |
Name__________________________________________________________________________ |
Address________________________________________________________________________ |
Phone# Day
_________________________Evening____________________________________
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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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Your appropriate non-refundable deposit must accompany registration.
All workshops require a $200 deposit.
The individual guest-lecture deposit amounts are on the guest lecture information page. Receipt of deposit
reserves your place in class. No registration will be made until deposit is
received.
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
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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 separate page, please include a few words about yourself.
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