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NOETIC HEALTH INSTITUTE |
Name:_____________________________________________________________________________
BBS Lic. Type:_________________ #:__________ BRN Lic. Type:________________ #:__________
Address: ___________________________________________________________________________
City: ______________________________________________ State:______ Zip: _________________
Phone: ___________________________________ Fax:_____________________________________
E-mail: _______________________________________ Credit______ or Audit______ (Please Check)
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FEES PER DAY |
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| Continuing Education Credit $ 99 if paid 30 days prior, 2 days for $188 $109 non-early registration, 2 days for $208 |
Audit (No CE Credit) $49 if paid 30 days prior, 2 days for $94 $54 non-early registration, 2 days for $108 |
Please Check All Seminar Date(s) You Plan to Attend
| Location |
Integrating Mind-Body Medicine into Your Practice |
Minding the Pain |
Tuition |
| San Diego, CA | ___ March 12, 2003 | ___ March 13, 2003 | $ |
| Sherman Oaks, CA | ___ March 18, 2003 | ___ March 19, 2003 | $ |
| Inglewood, CA, | ___ March 20, 2003 | ___ March 21, 2003 | $ |
| San Diego, CA | ___ March 25, 2003 | ___ March 26, 2003 | $ |
| Costa Mesa, CA | ___ March 27, 2003 | ___ March 28, 2003 | $ |
| San Bernardino, CA | ___ April 1, 2003 | ___ April 2, 2003 | $ |
| Orange, CA | ___ April 3, 2003 | ___ April 4, 2003 | $ |
| Pasadena, CA | ___ April 7, 2003 | ___ April 8, 2003 | $ |
| Carlsbad, CA | ___ April 9, 2003 | ___ April 10, 2003 | $ |
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Number of Seminars Taken: __________ |
TOTAL: |
$ ______ |
_____Check enclosed payable to: Noetic Health Institute VISA____ MasterCard____ Discover____ Am Express____ Credit Card #: ________________________ (Exp.___/___) Signature: _______________________________________ |
MAIL to: NOETIC HEALTH INSTITUTE 931 W. 19th St., #26 Costa Mesa, CA 92627 FAX to: |
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