Private Practice Class
Dates and Locations Below
Guest Information
Name
First Name
Last Name
Email (Please double check spelling)
example@example.com
Would you like to receive emails about future training opportunities with The Davis Group?
Yes please
No thank you
Which training will you be attending?
April 12-13, 2024 (Dr. Davis)
October 11-12, 2024 (Kelsey Thompson)
How would you like to attend the class?
Zoom
In person
Do you have private practice or business ownership experience?
Please Select
Yes
No
A little
If YES, what is the nature of your experience?
What what are your goals for the class?
How did you learn about our Private Practice Class?
What inspired you to come to this class?
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Payment
You can choose to reserve your spot with a non-refundable deposit and pay the balance via check or cash the day of the training, or pay the full amount now.
Please Select One
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next
( X )
Nonrefundable Deposit
$
100.00
Pay in Full
$
600.00
Total
$
0.00
Payment Methods
Choose from one of the PayPal options to
make your payment.
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