I declare that all of the informations provided below and in any supporting documents are accurate. By summiting this form, I hereby pledge to abide by the Code of Ethics.
(must match your legal IDs)
(#, Street, City, Province, Postal Code, Country)
(Name of School, #, Street, City, Province, Postal Code, Country)
Total Academic Hours Completed
(please provide copy of certification in person or email:
Totoal Hours of Massage Practice
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