Class Registration Form

Healing Touch Program™
Class Registration Form

Please print this registration form, fill it out and submit the registration form with
minimum deposit or full payment to the contact person listed for the class you wish to attend.

Name __________________________________________________________

Address _______________________________________________________

City __________________________  State ___________ Zip ________

Phone: Home ______________________ Work _______________________

E Mail: _______________________________________________________

Class Location _______________________ Class Date ____________
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Class Level: ___ 1  ___ 2  ___ 3 

Tuition: ____ Regular $333 

         ____ HTI/AHNA Member $308

         ____ Full Time Student With ID $225

         ____ Repeat $225
		 
Full tuition required for Level 1-3
	
Call the contact person to find out who to make your check payable
	to and where to send your payment.
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Class Level: ___ 4  ___ 5 

Do you need a level 4/5 notebook? ____ Yes   ____ No

Tuition: ____ Regular $459

         ____ HTI Member # ________________ $434

         ____ AHNA Member # _______________ $434

         ____ Full Time Student With ID $306

         ____ Repeat $306

Full tuition Required for Level 4 & 5
	
Checks for Level 4 & 5 classes make payable to Healing Touch and send to:
Healing Touch Program™, PO Box 16189, Golden, CO 80402

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Can you bring a massage table? _____ yes   ______ no

Are you a nurse ? Yes _____ No _____ Amount Enclosed $_________

The Contact Person for the class(es) for which you are registering, will send you a letter of confirmation.