First Name:

Last Name:

Street Address:

City:

Postal Code:

Phone:

Email:

I am interested in a:
Certification ProgramWorkshopBoth

If you're interested in a certification program, choose the program you wish to register for:
—Please choose an option—Aromatherapy CertificationAromatherapy Spa CertificationTeacher TrainingAromaMyology Massage CertificationIndie Head Massage CertificationReflexology CertificationHot Stone Massage Certification

If you're interested in a workshop, please fill in the name of the workshop:

Start date of Program/Workshop:

I will pay my fee by:
—Please choose an option—Money OrderCashE-Transfer

Additional Information:

I understand that by submitting this form, I wish to be registered for the program/workshop listed above, and that I am responsible for the associated fees. The balance of the program/workshop fees must be paid on or before the first day of class.

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