Enrollment Application Form

Below is the Registration form for our Equine Massage Certification Class.

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
Horse-related activities
Why is a career as a Certified ESMT of interest to you?
PAYMENT INFORMATION
Please accept my enrollment in the Armstrong Equine Massage Therapy Class.
On the next page, I am paying the full amount to cover the Armstrong Equine Massage Class with PayPal. I understand this is non-refundable.
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
I'm registering for the following classes:*
- Intro to Horse Massage - 1 day class $125
- 2 Day Horse Owners Class on Equine Sports Massage $595
- 4 Day AEM-1 Foundation ClassEquine Intensive Certification $1695 and paying in full and saving $50
- 4 Day AEM-1 Foundation Class Equine Intensive Certification $1695 and paying $400 Now & Remaining $1295 at class
- AEM-2 Master Class (after 4-day certification class)
Total Payable Fees
Price: $0.00
Note: PayPal automatically adds 3% fee for all transactions.

43529

PERSONAL INFORMATION