Workshop Registration
Complete form below to signup for one of my workshops
Name
First Name
Last Name
E-mail
example@example.com
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Louisiana License Number
How did you hear about the workshop?
Facebook
Friend/Colleague
Online Search
My Products
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Orthopedic Cupping
12 LA CEU hours w/ Cupping Set BLACK FRIDAY DEAL
$
275.00
Quantity
1
2
3
4
5
6
7
8
9
10
Orthopedic Cupping
12 Hour CEU class No Cup Set BLACK FRIDAY DEAL
$
225.00
Quantity
1
2
3
4
5
6
7
8
9
10
Comprehensive Prenatal
12 Hour LA CEU Class BLACK FRIDAY DEAL
$
225.00
Quantity
1
2
3
4
5
6
7
8
9
10
Payment Methods
Debit or Credit Card
Choose from one of the PayPal options to
make your payment.
Payment to Complete Registration
Should be Empty: