October Brain Training Registration Form
Deb Antinori, Trainer - October 15, 10am-5pm; & October 22, 10am-2pm 2021 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?
For SEBI/RMBI/MBI Members - $445 payable by Venmo to @Deborah-Antinori (4254 last four numbers of cell phone if needed), or by check to: Deb Antinori 87 Onderdonk Rd., Warwick, NY 10990. Please indicate below which method you will use.
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