Natural Approach to Health - Practitioner Healing Arts Training
Located at the Whitacre Springs Alternative & Complementary Health Centre,
3710 Whitacre Avenue, S.E. Minerva, Ohio

Certified Course Registration Form

In order to register for Practitioner Healing Arts Training courses and events, please
complete the registration form below and send with payment.  Payment in full
reserves your seat in the course or event. Tuition must be paid 14 days in advance. If you cancel
your reservation, a credit will be issued for another course or event of your choice.

Course/Event Selection:______________________Course Date: _____________

First Name:___________________ Last Name:__________________________

Business Name:___________________________________________________

Mailing Address:__________________________________________________

City:__________________ State:____________ ZIP:_____________________

Telephone:_________________________ Fax:__________________________

Email Address:____________________________________________________

May we add you to our email list?                    Yes             No

Payment Method:
Master Card    Visa Discover   Check    Money Order

Credit Card Number:_______________________________________________
Exp Date: _______________________________________________________
Authorized Signature:______________________________________________

Mail Completed Registration to:
Practitioner Healing Arts Training
3710 Whitacre Ave SE
Minerva, OH 44657

Or FAX to: (phone/fax): 330-868-4988