Miller-Motte College - Cary, NC
Massage Therapy Continuing Education - 2008 Registration Form
Name: _______________________________________________________________________
Street Address: ________________________________________________________________
City: _________________________________ State:__________________ Zip:____________
Phone (Day): __________________________ Phone (Night):__________________________
E-Mail: ______________________________________________________________________
Please Place A Check Beside Each Course In Which You Would Like To Register:
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□ Rhythmic Deep Tissue Sculpting - June 28-29, 2008 - $300 / $350 after May 30th |
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□ Advanced Myofascial Techniques: Special 1 Day Spine, Ribs & Lower Back - August 15, 2008 - $130 / $175 after July 23rd |
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□ Advanced Myofascial Techniques: Scoliosis - August 16-17, 2008 - $265 / $315 after July 24th |
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□ Holistic Aromatherapy Foundations Certificate Program - August 23-23 & September 20-21, 2008 - $500 / $550 after August 7th |
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□ Gentle Massage for Children - September 6-7, 2008 - $250 / $300 after August 8th |
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□ A Body/Mind Approach to Releasing Habitual Tension Patterns - September 12-14, 2008 - $375 |
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□ Pre- and Perinatal Massage Therapy certification program - October 2-5, 2008 - $575 / $625 after September 4th |
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□ Ethics: Focus on Transference/Countertransference - October 11, 2008 - $65 |
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□ Teaching Skills for the Workshop Leader - October 17-19, 2008 - $400 |
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Advanced Myofascial Techniques: Shoulder Girdle and Arm - |
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□ Massage for Children with Special Healthcare Needs - November 14-16, 2008 - $350 / $400 after October 17th |
Enclosed Is A Check For $_________________
Total Amount To Be Charged To My Credit Card: $______________________
Charge My (check one) _________Visa _________Mastercard
Name (as it appears on the credit card): __________________________________________________________
Billing Address (if different than above):__________________________________________________________
Credit Card Number: _________________________________CVV (3-digit code on back of card):__________
Expiration Date: _________________ Cardholder Name: ___________________________________________
Signature: ___________________________________________________________________________________
There Are Two Easy Ways To Register:
Phone: 919.532.7176
Mail: Miller-Motte College
Attn: Josh Herman
2205 Walnut Street
Cary, NC 27511
**Make Sure To Review All Registration And Refund Policies
**Please keep a copy of your registration form for your records
**Please Note - The Registration Form Will Print In Two Pages
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