Miller-Motte College - Cary, NC
Massage Therapy Continuing Education - 2010 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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□ Hot Stone Massage - March 27-28, 2010 - $325 |
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□ Head & Neck Part I - April 23, 2010 - $150 / $175 after March 30th |
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□ Whiplash - April 23-25, 2010 - $275 / $325 after March 31st |
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□ Assessment & Treatment of the Most Common Injuries - May 15-16, 2010 - $350 / $395 after April 15th |
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□ Reiki I (First Degree) - June 12-13, 2010 - $170 |
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□ Pre and Perinatal Massage - July 8-11, 2010 - $575 / $625 after June 8th |
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□ The Manifest Mind: Principles & Technique - August 27-29, 2010 - $375 |
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□ Assessment & Treatment of Shoulder Pain - August 14-15, 2010 - $350 / $395 after July 16th |
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□ Prosperity Consciousness - September 11, 2010 - $55 |
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□ Ethics : Integrity-An Exploration of Telling the Truth - September 11, 2010 - $55 |
| □ Ayurveda for Body Workers - October 23-24, 2010 - $300 + $25 material fee paid directly to the instructor |
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□ Pelvis, Hip & Sacrum Parts I & II - November 12-13, 2010
- $275 / $325 after October 15th |
| □ Pelvis & Sacrum III - November 14, 2010 - $150 / $175 after October 20th |
| □ Reiki I (First Degree) - December 4-5, 2010 - $170 |
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: 919.532.7153
Mail: Miller-Motte College
Attn: Nancy Harrell
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 May Print In Two Pages
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