Course Registration and
Ethical Agreement

This form must be completed prior to taking your class.

Name (as you want it to appear on your certificate

Street Address

City

Region/State/Province

Postal / Zip code

Country

Phone

Website (if any)

Name and email address of PayPal account holder who made the purchase (if different from your details above)

Name of your chosen instructor and course date

List your professional qualifications and any associations to which you belong

Upon qualification I agree to my name, town, country and email address being added to our practitioner Interactive Map

I have read and agree to the Cancellation Policy and Ethical Agreement

Thanks for submitting your course registration.

McLoughlin
Scar Tissue
Release®