Hot and Cold Stone and Hot Bamboo Registration Form.
October 28,29 2017
Massage At Monroe , Monroe, NC 28110 704 221 5872
Name: __________________________Title:___________ License # ________
Street: ______________________________________City: _______________
State: _________Zip: ______________ Email: _________________________
Phones: (W) ____________________________(C)_______________________
October 28,29 2017 14 hours $299 _______
Payment options:
2) Preferred method of payment: Check.
Make Check payable to Massage At Monroe and mail to:
Massage At Monroe, 2325 Hanover Dr, Monroe NC 28110.
3) 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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