HEALING TOUCH ALASKA MAIL-IN CLASS REGISTRATION FORM

Class Title(s) / Location(s) / Date(s):

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Tuition Enclosed (please note that not all classes have all payment options):

• Regular Tuition  $________
• Early Tuition  $________
• HTI Member  $________
• Full Time Student with Student ID  $________
• Repeat Tuition  $________

Total Enclosed  $________

Your Name:

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Your Address (Street or PO Box, City, State, Zip Code):

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Home Phone Number:

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Work Phone Number:

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E-mail Address:

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Can you bring a massage table to the class?

• ____  Yes
• ____  No

Please print this form, fill it out, and mail it to: Mary Szczepanski, 8536 Steep Place, Juneau, AK, 99801

Make checks or money orders payable to: Healing Touch Alaska