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Integrated Healing in LA 2016 Registration
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Name
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Phone Number
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Email Address
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Home Address
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How did you hear about IH?
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Are you a new student ? or retaker?
Yes, I am taking the following classes for the first time.
No, I am retaking classes.
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Classes you are going to register for
Module 1 Healing Pathway
Module 2 Healing Concepts
Module 3 Healing Body
Module 4 Healing Mind
Master Class 3
How would you like to make a payment?
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Emergency Contact Info
Name
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Emergency Phone Number
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Relationship
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