Spinal Raindrop Therapy Registration Form.

October 19,20 2019

Massage At Monroe , Monroe, NC 28110 704 221 5872

Name: __________________________Title:___________ License # ________

Street: ______________________________________City: _______________

State: _________Zip: ______________ Email: _________________________

Phones: (W) ____________________________(C)_______________________

Class starts at 8am sharp, Lunch is on your own at 1pm for 1 hour... we're done at 5:00p m.

Please bring your table, sheets, a bolster, and whatever cream you prefer. 

Class minimum 6, maximum, 16.

Dates TBA                  14 hours       $299 _______

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.

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