Training Registration Move towards your peak practice. Registration FormFirst Name *Last Name *Alias Mailing Address *Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabweCountryOffice Phone Mobile Phone *Email *Occupation/Practice *Massage TherapistYoga InstructorWellness CoachReflexologistEnergy Worker/HealerChiropractorAcupunturistOther (indicate below)Other Occupation/Practice Licensing State License # (if applicable)Name as you desire it to appear on your certificate of completion What are you most looking forward to learning at this training? What are you most looking for as a result of participating in this training? Cancellation Policy A credit in the amount of 100% of the purchased price will be granted if reservation is canceled prior to 24 hours for every day of live training reserved. If reservation is canceled less than 24 hours in advance, all fees paid will be forfeited. Payment is accepted in the form of cash, check or credit/debit card via PayPal online or in person. Please contact Darlene at 900.754.1153 is payment is due to be arranged. Note: Reservations are confirmed and secured only after partial or full payment has been made.Logistics Pinnacle Practice Live Training Saturday, March 12, 2016 9a-6p Exhale Spa Escapes 4294 Hughes Meadow Cv. Memphis, TN 38125 $49 (introductory special) $27 with promo code (if applicable) VerificationPlease enter any two digits *Example: 12This box is for spam protection - <strong>please leave it blank</strong>:
