Energetic Training For Massage Therapists Registration Form

Energetic Training For Massage Therapists
2008 Continuing Education

Registration Form
Please print this form, fill it out and send with your check or money order to:
2153 Ashland Ave Suite #3 Evanston IL 60201

Date of Class: All Sunday's	Class 1 Energy Based Healing for Massage Therapists February 10 Sunday Class 2 5 Element Massage Training March 9 Sunday Class 3 Ayurvedic Head Massage April 13 Sunday Class 4 Tuning Fork Training May 4 Sunday Class 5 5 Flying Star Movement For Massage Therapists June 8 Sunday Class 6 Energetics of Reflexology July 13 Sunday Class 7 Market Your Trade August 10 Sunday
Time of Class:	1:00-6:00pm
Location:	2153 Ashland Ave. Evanston IL. 60201
Name
Address
City, State & Zip
Telephone
Email address
Correct name for certificate
Total Amount Submitted	$	Check or Money Order #

Class Fee $675.00 .A non-refundable deposit of $100.00 is required to hold your seat.
All students must be registered and paid in full by February 10 2008.
There is a limited amount of seating and classes fill up quickly so please mail this form in
with your deposit. You will receive a confirmation call following the receipt of your registration.
Visa/MC/American Express/Discover accepted.

Office use only
Date Rec'd	initials of staff member recording info
Date Data entry complete	Date confirmation call	date Filed/assigned books & material