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Please select which class level and dates you plan to attend. Please select which class level and dates you plan to attend. Online Level 1 - December 12 & 13, 2020 Online Level 1 - January 9 & 10, 2021 Online Level 1 - February 12 & 13, 2021 Online Level 2 - January 20 & 21, 2021 Online Level 2 - February 17 & 18, 2021 Online Level 2 - March 13 & 14, 2021 Online Level 3 - January 27 & 28, 2021 Online Level 3 - February 26 & 27, 2021 Online Level 3 - March 24 & 25, 2021 Online Level 4 - February 5 & 6, 2021 Online Level 4 - April 10 & 11, 2021 Online Level 4 - May 15 & 16, 2021

I need Continuing Education / Contact Hours (CEs) for... (This is an added benefit of our Kinesiology classes and this service is offered at an additional $50 charge to the student per professional license) I need Continuing Education / Contact Hours (CEs) for... (This is an added benefit of our Kinesiology classes and this service is offered at an additional $50 charge to the student per professional license) Nurse Massage Therapist and Body Worker (NCBTMB) The National Athletic Trainer’s Association (NATA) Acupuncturists and Oriental Medicine (NCCAOM®) No, I do not need CEs to keep a professional license up-to-date.

Please select one. Please select one. I understand I must be present during all of the class times in order to receive CEs and I will bring my professional license number to class for the appropriate paperwork. I am not needing CEs but plan to attend all class times.

Precise Name on Certificate -Middle Name? Initial? (No designations please)

I understand that my... I understand that my... deposit is non-refundable but may be applied to a future class within 12 months.

How did you hear about this class? How did you hear about this class? Internet search TouchpointTherapy.com www.touchforhealth.us Word of Mouth Other (Please explain in message box below)

I am taking a Touch For Health Kinesiology class and I am... I am taking a Touch For Health Kinesiology class and I am... 18 years-old or older.

Please tell us a bit about your past experience with Touch For Health Kinesiology, if any...

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