BODYWORK WISDOM - Eeris Kallil Certified MassageTherapist. NCBTMB approved provider.

Massage Therapy Supports Healing from Breast Cancer registration and payment
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NCBTMB Approved Provider #451008-09

Registration information
Please read carefully:

BOULDER COURSE
Dates: Fri- Sat October 28th & 29th 9am-6pm
           Sun Oct 30th 9am-5pm 

23 Continuing Education Hours
Location: TBA

Cost:  $380.00 if registered before Sep 23rd
A non refundable deposit* of $75.00 is required by a check in the mail or by Credit card
After Sep 23rd a full payment of $400.00 is required

Registration closes Oct. 8th. All payments are due.

Note:  We will need Breast cancer survivors to work on. If you know any, please invite them to volunteer in our panel and hands on clinic on Sunday Jan 22 from 2-4:30pm.
volunteers should be POST treatment.

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 Oct. 28-30th of 2011 
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!
Print

If you have trouble submitting this form on line, please contact me ASAP via phone or email.

For Mail-in check payments: Please print this form and include it with your payment.
Thank you!

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 23rd, 2011)

MTSHFBC- $75 deposit

MTSHFBC final payment $305 (After $75 dep. paid by Sep 23rd, 2011)

Full Payment of $400 after Sep. 23rd 2011