THIS IS NOT AN ONLINE REGISTRATION FORM - FOR PRINT ONLY            Printed Date: 3/28/2024 2:53:56 PM

Seminar Title:
Myofascial Cupping Practitioner Certification
Seminar Date:
Thursday, June 11, 2020
Seminar Location:
FORT WAYNE, IN 46804
Seminar ID:
80659

  Required (select one)
 
$279.99 Single Registration
$249.99 2+ Group Rate: per person
$239.99 5+ Group Rate: per person
$140.00 Student
  ________ HI, NM attendees add applicable sales and local taxes**
  ________ Subtotal (Required items + sales tax)
 
  Optional
 
$69.99 Myofascial Cupping Starter Kit
$49.00 RockPods Cupping Set
$14.99 RockSauce Ice 3 oz – Pain Relieving Gel
$14.99 RockSauce Fire 3 oz – Hot Pain Relief and Tape Prep
$22.00 RockBand Flex Medium (Black)
$18.00 RockFloss (2" x 7')
  ________ AL, AR, AZ, CA, CO, CT, DC, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, NC, ND, NE, NJ,
NM, NV, NY, OH, OK, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY attendees add applicable sales and local taxes**
  ________ Subtotal (Magazines + Optional items + sales tax)
   
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  ** Tax-exempt customers please send a copy of your tax-exempt certificate.
  *** Registration for coordinator or military member discount must be completed online
  **** All prices are shown in US Dollars ****
 
 

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Mail or Fax to:
PESI Rehab, P.O. Box 1000, Eau Claire, WI 54702-1000      (800) 554-9775 (fax number)