Course Registration Form

First Name:*
Middle Name:
Last Name:*
DOB:*
Address:*
City:*
State:*
Zip:*
Primary Phone #:*     Home    Cell    Work
Email:*
Preferred Method of Contact: Primary Phone    Email
Occupation:

Name of class(es) for which you are registering:
Hydrotherapy for the LMT
More Clients Monday
Raindrop Techniques for the LMT
Oncology Massage
Ethics of Touch for the LMT
Stone Massage
Florida Massage Laws/Rule
Rejuvenate/Renew Your Practice
Intro to Canine Massage
Couples Massage I
Yamuna Ball Rolling for Self Care
Table Thai
Intermediate Canine Massage
Couples Massage II
Couples Massage III
Expecting Couples Massage
Adv./Cert. Canine Massage Therapist (75/100 hours)
     Module 1    Module 2    Module 3

Date of 1st Class:*
Name as you would like it to appear on your certificate of completion (ex. Jenifer Funk, LMT)
Would you like to be kept current on classes offered at Abundant Life Massage via email?*
Yes     No, thank you  

*We prefer checks made out to Abundant Life Massage as payment, however if you are paying with cash, please bring it with you to the first class.

**We do NOT sell or share your email with anyone, EVER, and you may ask to be removed *from our emailing list at any time.

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