Seminar Registration Form
Please fill in the information requested below. Your cooperation will enable us to make your educational experience better, help to ensure your continuing education credit and provide important feedback as to the venue and how we may improve.

We appreciate your feedback. Thank you.

Sincerely,
Healing Light Seminars 1601 Airport Blvd, Suite 1, Melbourne, FL 32901 (321) 751-7001
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Seminar Date and Location for which you are registering *
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Profession, State, License Number # *
Student Verification / Assistant or Office Personnel Verificaton
Healing Light Seminars offers training to licensed heathcare providers, students enrolled in an accredited institution with a relevant course of study at the time of registration, and assistants to or office personnel in the employ of a licensed health care practioner who has taken this course in the past or is currently registered. If you are a student, please indicate your school, course of study and anticipated graduation date. If you are an assistant to or working in the office of a licensed health provider who has taken or is presently taking this course, please provide the practitioner's name, company and proof of current employment.
Registration Type *
Name *
Company *
Required information has an asterisk.
Address (on License or Home Address if Student) *
City, State, Zip *
Phone number *
Email address *
How did you learn about the course? *
What would you most like to gain from this class? *
What about laser, leds and/or pulsed electromagnetic fields interests you? *
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