| Conference/
Workshop Registration Form |
|
name: |
|
Address:
|
| Address: |
| city:
state: zip: |
| PHONE:
FAX: |
| e-mail |
| I have read the cancellation policy.
Initial___ |
| Payment by __check
__Mastercard __AMEX, __VISA |
| #________________________________
exp.__________ |
| signature_________________________ |
| Total $______ incl 3% non-cash/check
surcharge if applicable |
| Register me for: |
- __Full meeting
- __Combination Full Meeting and EEG BF
Fdtns Course
- __1 Day __2 days __3 Days __4 Days
|
- __One Day Pre-conf. EEG BF Fdtns. s
Course
- __ 10 hour Workshop Package
- __Optimal Functioning and Positive
Psychology Meeting (included in full meeting price)
|
|
Comments?
|
|
Send payments to Futurehealth, Inc. Call phone,
fax or e-mail
- WBM @ Futurehealth, Inc.
- 211 N. Sycamore St.
- Newtown PA 18940
- voice 215-504-1700 fax 215-860-5374
|
