CoAT Course Application Form
Thank you for your interest in CoAT. Welcome!

As part of pre-registration and in order to serve you well, please fill out this form. Once you submit the form we will send you the course package for you to review and PRINT. Please bring your own printed material to the course. If you have any challenges please let us know. I am here to help you in any way we can to bring CoAT to you.

Marjorie Haynes RMT
Email address *
Full name (exactly as you would like it to appear on your certificate) *
Your answer
Contact Phone Number *
Your answer
Preferred email address to be used for communication *
Your answer
Full billing address *
Your answer
Course name and date you are registering for? *
Your answer
Package pricing option you would like? *
Are you practicing RMT? (If no, please describe your experience with manual therapy) *
Have you attended any of Marjorie's CoAT courses previously? If yes, which one(s)? *
Your answer
Do you have any health or physical challenges you would like support with? *
How did you hear about CoAT Method?
Your answer
Any other comments/questions you would like to share: *
Your answer
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This form was created inside of Open Door Healing Arts.