* Email:

* Name:

* Address:

* City:

* State:

* Zip:

* Home Phone:

Work Phone:

Place of Employment:

* Course Location:

* Course Dates:

Payment Method:
Check Credit Card (through Paypal)

Tutition is $375.00
A non-refundable course deposit of $100.00 is due at the time of registration, plus the cost of the books. A $25.00 discount is given if balance of tuition is paid 21 days prior to the first day of the workshop.

Refund (less $100 cancellation fee) will be given if written cancellation notification is received 21 days prior to training. No refunds after the 21 day deadline. Fee can be applied to another workshop.

You will be taken to the next step to pay for your workshop after filling out this form!