SRM SEMINAR - MAIL-IN REGISTRATION FORM

I would like to register for the SRM seminar. I prefer to enroll (check one):

with Medical Massage textbook ($250)
without Medical Massage textbook ($200)|

We accept checks, money orders, VISA, MC, AMEX, DISCOVER. Please provide the following information:

Print your name (as you want it to appear on the certificate)


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Your address

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Your phone ............................................................................

 

For registration by credit card please provide account # .................................................................................................

 

Exp. date...............................................................................

 

Billing address (if different from mailing address) .........................................................................................................

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SEND TO:

AESCULAPIUS BOOKS, P.O. Box 22064, Phoenix, AZ, 85028