Registration Form

The full tuition amount is due with registration unless other arrangements have been made.
Please complete the registration form with your name as you wish it to appear on your certificate
(if applicable) and submit with your check payable to Janine Sousa to:
Janine Sousa
Healing Touch
45 Princeton Street
Chelmsford, MA 01863

Please print
Name___________________________________________________________________________
 
Address__________________________________________________________________________
 
_______________________________________________________________________________
 
Telephone #______________________________e-mail ____________________________________
 
Workshop ________________________________________________________________________
 
Date of Workshop__________________________________________________________________
 
Amount enclosed ______________________________Check #_______________________________
 
My signature below indicates that I have read and agree to the cancellation policy.
 
__________________________________________________________________________________
 
 

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