HEALING TOUCH LEVEL 1REGISTRATION

(Please print this page and mail with your payment to 'send to' address indicated below)

Marilee Tolen
The Center for Life Enhancing Medicine at Samaritan Hospice, Marlton, NJ
March 18-19, 2006

Name: ___________________________________________________________

Address: _________________________________________________________

City: _____________________________ State: ____________ Zip: __________

Home Phone: ______________________________________________________

Work Phone: ______________________________________________________

E-mail: ___________________________________________________________

____ Regular Tuition $350 (includes syllabus)

____ HTI or AHNA Member Tuition $325 (includes syllabus)

____ Repeat $225 (no syllabus)

$_________ Amount Enclosed ($50 min. dep.)

Can you bring a massage table?    Yes ____  No ____

Register Early - Enrollment Limited!

PAYMENT INFORMATION

Credit Card: (Visa, MC, American Express, Discover)

Card Number: _________________________________________ Exp. Date: _______________

Name on Card: ________________________________________ Amount: ________________

Signature: ____________________________________________

Or,

Make check payable to: Marilee Tolen

Mail payment to:
Dawn Peralta
410 Sheffield Road
Cherry Hill, NJ 08034
(609) 929-4309

Directions and lodging information will be sent with confirmation letter.
Contact Person:   Dawn Peralta    /   Phone:   (609) 929-4309

Non-refundable $50 deposit due by March 3rd to reserve space.