Thai Massage Level 1 Registration

Level 1: Traditional Thai Class Registration Form

Traditional Thai Level 1 Date you are Registering for?*
First Name*	Last Name*
Your Name as you would like it to appear on Certificates/Diplomas. Please include any designations (RMT,CMT,LMT, RYT, RN...)*
Cell Phone	Home Phone
Work Phone	Email Address*
Mailing Address*	City*
State	Zip Code*
Birthdate	Occupation
Emergency contact person	Phone
How did you first hear about Thai Massage?
What first drew you to Thai Massage - what intrigued, inspired ad peaked your interest about this healing art?
What are your goals in learning Thai Massage?
What is your previous background with the healing arts - bodywork, yoga, acupuncture, herbs, ect?
What do you plan to do with this training?
Please name a strainge, quirky thing about yourself that makes you unique. (For example:" I am the milk-smeller of the family")
Deposit A deposit is required to reserve a place in our intimate training experience (10 student maximum). Your deposit for each training and for the "Bundle and Save" packages is non-refundable should you cancel out of your selected class when the scheduled workshop takes place. We will refund 100% of the deposit for any canceled training due to our responsibility. When buying airfair, we suggest using Southwest airlines when possible as they dont have a penalty for changing reservations. Please mail check or money order to: Symmetry Therapeutic Massage Spa 2416 W 32nd Ave. Denver, Colorado 80211
Tuition* Deposit ($350) Full Tuition ($925)	Payment Method* Mail CheckCredit Card (PayPal) Mail Money OrderCredit Card (Phone)
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* Required

Located in the Highlands Wellness Center