Private Practice Class Registration Form

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?
How would you like to attend the class?
Do you have private practice or business ownership experience?
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?
I understand that I am required to pay a nonrefundable deposit of $100 now and $400 prior to the start of the class. Payment can be made via Venmo to drseandavis; Zelle to drdavis@thedavisgroup.org; or by mailing a check to the Roseville address at https://thedavisgroup.org.
I acknowledge and agree that I will bring proof of full Covid vaccination status or a negative test from two days prior to the training in order to gain admission to the training. The failure to bring these documents to the training will result in forefeiture of any payments made.
Upload proof of vaccination (not required for Zoom)

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Cancel of
Confirmation By acknowledging and signing below, I am delivering an electronic signature that will have the same effect as an original manual paper signature. The electronic signature will be equally as binding as an original manual paper signature.
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