Name           

Address       

Home Phone

Cell Phone   

Are you a student? Yes No
(If Yes) Name of Massage School or Institution

Are you a graduate of Massage School/Institution? Yes No
(If Yes) Name of Massage School or Institution

Are you thinking of being a Massage Therapist? Yes No


How did you hear about us? ---- choose one ---- newspaper ad flyer friend other
(other)

Which session are you registering for? ---- choose one ---- September 21, 10am - 12pm September 21, 2pm - 4pm September 21, 6m - 8pm September 23, 10am - 12pm September 23, 2pm - 4pm

Please give us your second choice, in case your first choice is fully booked. ---- choose one ---- September 21, 10am - 12pm September 21, 2pm - 4pm September 21, 6m - 8pm September 23, 10am - 12pm September 23, 2pm - 4pm

Important!
Print out this completed form before submitting. You need to mail in a copy of this registration form with your payment.


After printing, please click the button below to

Mail checks or money orders to:
Massage Effex
1142 Diamond Bar Blvd., Suite 143
Diamond Bar, CA 91765
Please make all checks or money orders payable to Massage Effex.

To speak with a Massage Effex representative please call (626) 806-0921.