Information & Registration
I am interested in learning more about your Holistic Massage Therapy Institute.
Name: ______________________________________________________
Address:_____________________________________________________
City_______________State_________________Zip Code_______________
Phone (Home)_______________(work)_________________(cell)_______________
Email address ______________________________________
____ Please send me your brochure
____ Please reserve a space for me in your next Basic Class
____ Please reserve a space for me in your Advanced Class
____ Please reserve a space for me in one or more of your individual classes
____ My Deposit is enclosed (this will hold your space and allow you to be registered. If you should have to cancel, speak with a teacher or A Diamond for terms.
Only 16 students will be accepted in each class
The reason I want to be a massage therapist is:
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Signed:____________________________________ Date:___________________
Print out this page, fill it out and fax it, or mail to the address above.
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