Read Seminar_Application_Form_2011.pdf text version

Pre-registration is required as class size is limited (no phone registrations). Please mail or fax application form along with a copy of license/credentials, Student Agreement Form (required for Basic Seminars), and payment to: NAET Seminars, 6714 Beach Blvd., Buena Park, CA 90621, Fax (714) 523-3068

Name (Type or Print): Degree or Diploma: Year Graduated: Business Adress City: Phone: License # (Copy of license/credentials needed with application form) State: Mobile: Zip: Fax: Country: Email:

2011 NAET® SEMINAR APPLICATION FORM Seminar Location: 6714 Beach Blvd., Buena Park, CA 90621

Special Considerations (Please note if you have any disabilities, conditions, diculty with the English language, etc.)

BASIC SEMINAR*

Student agreement form

ADvANCED LEvEL 1 ADvANCED LEvEL 2 AND

February 12-13, March 05-06, April 09-10, May 07-08, June 04-05, August 13-14, Sept. 10-11, Nov.05-06, and Dec. 03-04 April 16-17, July 09-10, September 17-18, December 10-11. March 12&13 (I&J), June 11&12(K,L), July 31(D), Aug. 20 &21 (M&N), Sept.24/25(O&A), Oct. 22& 23 (B&E), Oct. 29 &30 (P&Q), Nov. 12-13 (C1, C2). Symposium -2 days (July 29-30) NST Instructor's class (Oct.7) Adv. 2 D (July 31)

$630.00 1st time $315.00 Refresher $540.00 $315.00 Refresher $420.00 $120.00 $630.00 $210.00 $210.00 Total

NST Class only

17th ANNUAL SYMPOSIUM (Location-Buena Park)

PAYMENT METHOD CHECK (Please enclose check made payable to Dr. Devi S. Nambudripad) [ ] vISA [ ] MASTERCARD Credt Card # [ ] AMERICAN EXPRESS

[ ] DISCOvER Exp. Date

I agree to pay above total amount according to Card Issuer Agreement (Merchant Agreement if credit voucher)

Signature of Card Holder

Date

*Mandatory reading before attending Basic seminar: "Say Good-bye to Illness" by Dr. Devi S. Nambudripad (This book

will be mailed to you free of charge if your registration is confirmed two weeks prior to the Basic Seminar date.)

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