Appendix - Healing Touch Program
Appendix - Healing Touch Program
Appendix - Healing Touch Program
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<strong>Appendix</strong><br />
Level 1 Instructor Certification Application<br />
Level 1 Instructor Certification Application<br />
Submission Date ___________________<br />
Name _________________________________________________________________<br />
Last<br />
First<br />
Address _______________________________________________________________<br />
City ______________________________ State/Province ______________________<br />
Zip/Postal Code _____________________ Country __________________________<br />
Credentials: ________________________<br />
Practitioner Certificate # ______________ Certificate/Renewal Date ______________<br />
Include the phone number(s) and email address you want HTP to use for communication:<br />
Home Phone ________________________<br />
Home Email _________________________<br />
Cell Phone __________________________<br />
Work Phone ________________________ Work Email __________________________<br />
Other _____________________________<br />
Please fill out and attach the Application Checklist and related materials.<br />
SEND PACKET TO:<br />
<strong>Healing</strong> <strong>Touch</strong> Certification<br />
Certification Administrator<br />
P.O. Box 16189<br />
Golden, CO 80402<br />
____ Enclosed is a check or money order for $50.00<br />
____ Please charge $50.00 to my credit Card Please Circle One: VISA M/C<br />
Card Number __________________________ Expiration Date: _________<br />
Three digit safety code ________<br />
Your Signature ___________________________________<br />
Office Use Only: Auth # _____________________ CC Order #______________________<br />
© Copyright 2008 <strong>Healing</strong> <strong>Touch</strong> <strong>Program</strong> HTP-930 03.26.08<br />
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