STAR Tech Healing and Learning Center
Public Workshops for Pain Management and Improved Wellness
Public Workshop Registration Form
Download and print this form to register for a Public Workshop.
Mail the completed Registration Form to arrive by the Pre-Registration Date,
with full payment for the Workshop(s) you plan to attend.
Workshop I plan to attend
|Good Vibrations - Exploring Universal Energy, Chakras & Healing Touch||
April 22, 2018
Please make check payable to: Barry L.
Mail to: STAR Tech Healing and Learning Center, 14 Nason Street, Suite 202, Maynard, MA 01754
Your Name: ___________________________________________________________(please print clearly or type)
Telephone: Home: ____________________ Work:
For Physical Workshops: I certify that I am in good health and there is no reason that I can not engage in a full
gentle Stretching /Exercise/Yoga program.
Certificate of Completion for Professionals taking these Workshops for CEUs:
____ I do want, ____ I do not want a Certificate of Completion for the Workshop(s) I am attending.
Please show my name as:________________________________________________________ (please print clearly or type)
I learned of these Workshops from:
___ Newspaper, ___ Magazine, ___Poster, ___ Internet,
___ e-mail, ___ Friend, Family or Co-worker, ___ Previous Workshop, ____ Sign on street,
___ Other – Please Name the Source _____________________