Canine Certification Class Registration

Armstrong Canine Certification Class $695

Enrollment Application
PERSONAL INFORMATION
Name as you want it to appear on Certificate*
Date
MM slash DD slash YYYY
Address
Street*
City*
State*
Zip Code*
Phone*
Email*
Referred By
Are you 18 years of age or older?
- Yes
- No
GENERAL
Please limit responses to two lines. If you would like to provide more information, please do so on a separate document.
Subjects of special study or interest
Canine related activities
Why is a career as a Canine Massage Therapist interest you?
PAYMENT INFORMATION
Please accept my enrollment in the Armstrong Canine Certification Program.
On the next page, I am paying $695.00 to cover the Canine Certification Class with PayPal.
The class I want to register for start date is:*
MM
DD
YYYY
What's your second choice in case first choice class is full?
Month
Day
Year
Note: PayPal automatically adds 3% fee for all transactions.
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