Individual Registration

Please enter information in the form below to process registration for the class Northern Thai Massage Part 1 Supine.

When registering please list your name as you would like it to appear on your certificate.

First Name *

Last Name *

Address *

Address 2

City *

Zip *

State

Phone

Email *

Comment

Amount

Payment Method

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Holder Name*

Credit or debit card*

By registering for this class, I accept Terms and Conditions