REGISTER HERE... Your Name:  * Address:  * City:  * State:  * Zip Code:  * Phone number:  * Email Address:  *   CLASS INFO... I would like to register for: Barefoot Basics Anterior/Side-Lying Advanced Ashiatsu Ashi-Thai You'll choose your class dates in a couple of minutes! I would like to pay by: Credit Card Paypal Check Money Order *Payment instructions will be given when the form is submitted.   Deposit or Pay in Full? Deposit Basics: $250 Deposit Anterior: $100 Deposit Advanced: $250 Deposit Ashi-Thai: $200 Full Pmt Basics: $595 Full Pmt Anterior: $199 Full Pmt Advanced: $498 Full Pmt Ashi-Thai: $399 Linen rental ($10/day)? Yes No

HELPFUL INFORMATION... Your height: Your weight:   Massage room measurement floor to ceiling: If you don't have the measurements now make sure you bring them to class. How low does your table go? How high does your table go? Name as you would like to appear on certificate. Please include any designations such as RMT LMT CMT etc.   I look forward to having you in class! Any questions or comments for Mary-Claire? If paying by check or MO please enter date of class here. Security code:   * Do not enter anything in this field:

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