PLEASE COMPLETE THIS FORM IN FULL AND SUBMIT. ONCE YOU CLICK SUBMIT, YOU WILL BE REDIRECTED TO PAYPAL TO MAKE PAYMENT.

Class you will be attending:

Name

First Last

Address(Required)

Street Address City State ZIP Code

Phone(Required)

Iowa Massage Therapist License, or if not applicable put NA(Required)

PLEASE NOTE THAT YOUR REGISTRATION IS NOT COMPLETE UNTIL PAYMENT IS RECEIVED. TO COMPLETE REGISTRATION CLICK ‘SUBMIT’ AND YOU WILL BE RE-DIRECTED TO PAYPAL FOR PAYMENT.