Registration Form
Asheville, NC // March 23-24
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
Please enter a valid phone number.
Where are you from or currently living?
What is your occupation?
What is your optimal wish and inspiration for taking this course?
Are you a Licensed Massage Therpaist:
Yes
No
If you are a LMT, please provide your license number.
Signature
*
Payment
My Products
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( X )
Course Tuition
$
350.00
Deposit
Claim your Spot // Non-refundable // Tuition due March 20th
$
115.00
Tuition Balance
Please pay balance by March 20th
$
235.00
Quantity
1
2
3
4
5
6
7
8
9
10
Work Trade
Only eligible for people asigned by Dominique.
$
150.00
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Submit
Should be Empty: