Registration Form
Sedona, AZ // October -12-13, 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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Course Tuition
$
369.00
Deposit
Claim your Spot // Non-refundable // Tuition due April 27th
$
115.00
Tuition Balance
Please pay balance by April 27th
$
255.00
Work Trade
Only eligible for people asigned by Dominique.
$
150.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Submit
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