Massage TOOLS for Healthy Returns.

Registration Form.

January 7, 2017

Massage At Monroe , Monroe, NC 28110 704 221 5872

Name: __________________________Title:___________ License # ________

Street: ______________________________________City: _______________

State: _________Zip: ______________ Email: _________________________

Phones: (W) ____________________________(C)_______________________

January 7, 2017              8 hours       $149 _______

Payment options:

1)  Preferred method of payment: Check.

     Make Check payable to Massage At Monroe and mail to:

     Massage At Monroe, 2325 Hanover Dr, Monroe NC 28110.

2)  Credit Card # _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Exp _ _ / _ _ 3 digit code on reverse _ _

_________________________________________________________

Signature (I agree to Grand Total charges above) Fax to 704 282 4683

For any additional questions or registration by phone please call Carmen at 704 221 5872.