April 2024 Brain Training Registration Form
Deb Antinori, Trainer - April 19, 2024 & April 26, 2024 10am-5pm EASTERN
Brain Science to Inform Your BSP Practice: AKA Animal Brain Gone Wild!
(The Unabridged Version)
Name
*
First Name
Middle Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
*
example@example.com
Mobile Number
*
Work Number
Company
License Number:
*
Trainings taken and dates:
*
Any neuroscience background?
*
Payment of $495 (If paying by credit card, there is a $16 processing fee for the credit card company, so fee goes up to $511 in that case). $50 off for Institute Members with your registration number: RMBI, SEBI, MBI
Please Select
Venmo- @Deborah-Antinori
Zelle- Deborah Antinori, 908-507-4254
Check- Mail to: 1 Harborside Place, Apt 158, Jersey City, NJ 07311
If you have any questions, please contact Deb at dantinori@gmail.com.
If you are a Grad, please type “Yes”
Registration number: RMBI, SEBI, MBI
Submit Application
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