REI Institute Authorized Provider Training Seminar Registration Form

Print this form and mail to: REI Institute 55 Lime Kiln Road Lamy, NM 87540 USA

or fax to: 505-466-6144 Credit card registrants may call: 505-466-6334 or 800-659-6644

Seminar Date and Location (enter the date and location which you'd like to attend):

_____________________________________________________________________

Registration Fee:

______ $225.

The seminar fee includes all training materials, Calming Rhythms 3 CD, Introducing Rhythmic Entrainment Intervention DVD, and lunch and refreshments during the training.

As well, you recieve $100 savings on the cost of the first set of REI Therapy Program CDs that you order for yourself, a family member, or a client.

Payment Type:

_____ Visa ____ Mastercard ____ Discover ____ American Express ____ Check (mail order only)

Card#: _______________________________________ Expiration Date: _________

Name as it appears on the card: _________________________

Signature: _________________________________

Contact information:

Name: ___________________________________ Phone: _____________________

Company: ___________________________________ Fax: _____________________

Nature of practice: _______________________________________________________

Email: ______________________________________________

Address:______________________________________________

City: _____________________ State: _____________

Postal/Zip code: _________________ Country: ___________________

 

Cancellation policy:
Tuition is refundable up to 14 days prior to the seminar date. Tuition is non-refundable less than 14 days prior to the event, but is transferable (subject to a $40 transfer fee) to a future seminar provided there is space available.