STAR Tech Healing and Learning Center
Training Workshops for Massage Therapists and Bodyworkers
  
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
 STAR Tech Treatments for Arms, Hands and Lateral Shoulders  Feb. 26, 2011  
  STAR Tech Treatments for Neck and Medial Shoulders  Feb. 27, 2011  
 Both STAR Tech Upper Body Workshops  Feb. 26 & 27  

  *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

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 12-15-10

Training Workshops