REGISTRATION FORM FOR:

Playshops

 

 

Name:_____________________________________________________ Address:___________________________________________________
City:_______________________________________________________
State:________Zip Code:________________ Country:________________
Telephone # :_______________________________________________
E-mail Address:______________________________________________

DC/Student: Chiropractic college: _____________

Playshops require a minimum of 12 registered participants 6 weeks prior to the date
in order to be considered a "go."
A $100 nonrefundable deposit must be received in order to reserve your spot, and to ensure the Playshop.

PLAYSHOP INVESTMENT:

_____ $175: Student
_____ $225: Doctor