Massage Awareness - Registration

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Massage Awareness - The Standard For Animal Massage Continual Education

Registration

First Name*
Last Name*
Date of Birth
Address 1
Address 2
City
State/Province
Country
ZIP/Postal
Phone*
Email*
How did you hear about us?
Which course are you registering for?
Choose type of course	Private Tutoring Group Class
Your goal in attending this couse
Do you wish to bring your animal?	Yes No

Payment: Send cashier cheque or money order only, made to:
Massage Awareness Inc.

Send to:
Massage Awareness Inc,
11924 Forest Hill Blvd, Suite 22-102,
Wellington, FL. 33414. USA

If you have any particular question, you can contact Jean-Pierre directly by email jptopmassage@yahoo.com or by phone (561) 537-0366

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