CHINATOWN WELLNESS CENTER

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					                 CHINATOWN WELLNESS CENTER
                                           presents the

        ONE YEAR PROGRAM: HEALING WITH GEMS & STONES

                      (A CHINESE MEDICAL PERSPECTIVE)
                                       REGISTRATION FORM
                                      PLEASE PRINT CLEARLY



NAME___________________________________________________________

ADDRESS________________________________________________________

CITY/STATE ___________________________                           ZIP ___________________

TELEPHONE (HOME) ________________                            (OFFICE) ___________________

EMAIL ADDRESS (OPTIONAL)_________________________________________

_____________________________________________________________________________
Please check one



      One payment of $2,300.00 a year paid in full before December 17, 2012.



      Two payments of $1,300.00 a year
      (1st payment before December 17, 2012 & 2nd payment by April 27 2013).




**NOTE: After December 17, 2012 the new payment will be $2,500.00.
   And for the Two payment option after December 17, 2012, each payment will be $1,500.00.

Make checks payable to

                                Chinatown Wellness Center, LLC
                                     52 Walker St. 2nd Floor
                                      New York, NY 10013
                               (212) 966-8830 fax: (212) 966-8845
                                       www.cwcherbs.com

              Register Early to ensure your enrollment, as class will be limited.

                                         CEU - PENDING

No audio taping or videotaping of class will be permitted.

				
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