Core Alignment registration and payment

Bodywork Wisdom

Massage Therapy Supports Healing from Breast Cancer registration and payment

| | | | | | | | | | | | |

NCBTMB Approved Provider #451008-09

Registration information
Please read carefully:

BOULDER COURSE
Dates: Fri- Sat October 22-23 9am-6pm
           Sun October 24th 9am-5pm

23 Continuing Education Hours
Location: Health Links Clinic
                3101 Iris Avenue Suite 200,
                Boulder, CO 80301

Cost: $380.00 if registered before Sep 24th
A non refundable deposit* of $75.00 is required by a check in the mail or by Credit card
After September 24th a full payment of $400.00 is required

Registration closes October 8th. All payments are due.

Note: payment by credit card is available online only!

Please make payment to: Eeris Kallil CMT

Send payment to:
Eeris Kallil
737 29th Street Ste 200
Boulder, CO 80303
Please include a copy of this registration form

Cancellation:
30-14 days prior: If paid in full- a full refund minus non refundable deposit
14-7 days prior: If paid in full- 70% will be refunded minus NR deposit
6-4 days prior: 50% minus NR deposit
3-1 days prior: no refund will be offered.

Class cancellation:
If the class is cancelled by the instructor- students can choose to receive a full refund including the deposit or a credit for the next course.

*If cancellation is more than 30 days prior to the workshop date deposit will be fully refunded

Please fill out the form bellow and submit.

Registration form
MTSHFBC Boulder October 22-24, 2010
Please fill and submit the form below
To print a copy of this form, first press "print this" at the end of the form, fill in the form, print it and then press submit.
If you do not get a confirmation email or call within 72 hours, please contact me at 303-775- 8005 or email: eeriskallil@aol.com

Full Name:

* required

Home phone:

Mobile phone:

Business phone:

Mailing address:

Email:

* required

Best way to contact you:

By email

By home phone

By mobile

By business phone

Massage Education

Massage institute attended:

* required

Are you a graduate or a student?

Graduation year (if not a student):

Total of program hours completed:

* required

Do you have any questions?

How did you hear about this workshop?

Payment Information

Choose your payment option:

Refer A Friend

Do you know of someone I should contact about this workshop?
please include their name and email address. Thank you!

When you send a check in the mail please print this form and include it with your payment.

BUDDY DISCOUNT: Refer a friend and each of you will get $20 off. Please contact me for payment arrangements 303 775 8005 or email: eeriskallil@aol.com

Online payment options:

Massage Therapy Supports Healing from Breast Cancer: $380 Full Payment (if paid by Sep 24th, 2010)

MTSHFBC- $75 deposit

MTSHFBC final payment $305 (After $75 dep. paid by Oct 8th 2010)

Full Payment of $400 after Oct 24th