DISCOVER REFLEXOLOGY - Course Registration
Email *
** Course registrant or student are herein referred to as STUDENT; Course provider, Discover Reflexology, and Trenna Reid are herein referred to as DISCOVER.
STUDENT INFORMATION
First Name *
Last Name *
Street Address *
P.O. Box
City *
Province *
Postal Code *
Mobile Phone Number
Home Phone Number
EMERGENCY CONTACT INFORMATION
Please provide the name and phone number of a person to contact on your behalf in case of an emergency
Emergency Contact Name
Emergency Contact Phone Number
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