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


 Date Fee
Good Vibrations - Exploring Universal Energy, Chakras & Healing Touch


 April 22, 2018

  Workshop Total



Please make check payable to: Barry L. Bailey

Mail to:
STAR Tech Healing and Learning Center, 14 Nason Street, Suite 202, Maynard, MA 01754

Your Name:
___________________________________________________________(please print clearly or type)

Address: _______________________________________________________________________________

Telephone: Home: ____________________ Work: ____________________ Email: __________________

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.

Signature: _____________________________________________________Date:____________________

        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  _____________________

                                                                                                                                Revised 3-3-18
Public Workshops