STAR Tech Healing and Learning Center
Training Workshops for Massage Therapists, Body Workers and Others
 
Advanced Training Registration


Download and print this form to register for a Professional Training STAR Tech Workshop.
Mail the completed Registration Form with full payment or with a deposit.

Workshop(s) I plan to take

Date Cost
 Use & Share Active Stretching  February 2, 2013  
     

  *Please Double Check for Possible Discounts     

   

   Deposit     

   $

   Balance Due Day of Workshop    

   $

 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:
_____________________________________________________________

Address: ___________________________________________________________

Telephone
: Home: _________________ Work: ___________________

E mail
:  ___________________________________________________
I am a
 ____ Massage Therapist; ____ Physical Therapist; ____ Chiropractor;
 ____ Fitness Trainer; ____ Coach; ____ Student; ______________________ Other


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:____________

Certification of Completion
____ I do want, ___ I do not want a Certificate of Completion for the Workshop(s) I am attending.
On my Certificate of Completion, please show my name as:

________________________________________________ (please print clearly or type)

I learned of these Workshops from: ___ Newspaper, ___ Magazine, ___Poster, ___ Internet,

____ e-mail,____ Brochure, ___ Friend or Co-worker, ___ Previous Workshop,

___ Other Please Name the Source ________________________________

                                                                                                                                        Revised 1-14-13

Training Workshops