Energetic Training For Massage Therapists Registration Form

Energetic Training For Massage Therapists
2009 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 January 18 Sunday Class 2 Ayurvedic Head Massage February 15 Sunday Class 3 Tuning Fork Training March 15 Sunday Class 4 5 Flying Star Movement For Massage Therapists April 19 Sunday Class 5 Energetics of Reflexology May 17 Sunday Class 6 5 Element Massage Training June 7 Sunday Class 7 Market Your Trade July 12 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 January 18 2009.
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