February 2023 Brain Training Registration Form
Deb Antinori, Trainer - February 17, 2023 10am-5pm; & February 24, 2023 10am-2pm 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
Please Select
Venmo- @Deborah-Antinori
Zelle- Deborah Antinori, 908 507-4254
Check- Mail to: 512 Philadelphia Blvd, Sea Girt, NJ 08750
If you have any questions, please contact Deb at dantinori@gmail.com.
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