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Class Registration

Please enter information in the form below to register for May 14-16 3-Day Level 1 Course.

First Name *

Last Name

Name on Certificate

Company / Organization

Address

Address 2

City

Zip

State

Preferred Phone *

Secondary Phone

Email *

Shirt Size *

Payment Information

Amount

$

Deposit Amount

$

Payment Type

Payment Method *

Credit Card / Paypal Check (by mail)

Credit Card Number*

Expiration Date*

/

Card (CVV) Code*

Card Type*

Card Holder Name*

Verify that you're a real person*