3 Day Lomi Lomi Workshop • Tampa, FL • January 14-16, '11
Sacred Lomi: Hawaiian Temple Bodywork
Earn 24 NCBTMB Continuing Education Hours
THIS FORM IS FOR PRINTING ONLY
| Name (as you'd like it on your certificate): ___________________________________________________________________ |
| Address: ___________________________________________________________ |
| City: _________________________________________ State: ________________ |
| Zip: ____________________ Phone(s): ___________________________________ |
| Email: _____________________________________________________________ |
| For Credit Cards: _____ Visa ____ MC ____ Discover ____Amex |
| Cardholder's Name: _________________________________________________ |
| Card #: ___________________________________ Exp. Date: ___________ |
Signature: ___________________________________________ |
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If credit card billing address differs from the above address, please include your billing address here
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_________________________________________________________________
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_____ Yes, I have a massage table I'm willing to bring.
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Amount Enclosed
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| ____ $450 Early Registration by December 14th _____ $495 after December 14th, OR... |
| _____ $100 deposit _____ Please charge the remaining balance by the early registration deadline. |
| ______ I will pay the remaining balance by mail or by calling in at a later date |
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Checks should be payable to Sacred Lomi, LLC
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Space is limited. Registration is on a first come, first serve basis. To guarantee your space, send $100 non-refundable deposit.
Cancellations after January 8th will forfeit their tuition. Please print and mail this form with check or credit card info to:
Sacred Lomi: Hawaiian Temple Bodywork
PO Box 1206, Agoura Hills, CA 91376-1206 • Phone & Fax: (818) 865-8813
Workshop Location
Hampton Inn Clearwater Central
21030 US Highway 19 North Tampa, Florida 33765 (727) 797-8173
We will send a welcome packet with a list of what to bring and a receipt two weeks before the class.
For specific questions about the class, please contact Tom or Donna at:
Sacred Lomi
(818) 865-8813 • www.SacredLomi.com