REGISTRATION
 





Registration & Payment Instructions
Fill in the form below and click "submit".
We will respond with payment verification via email.
If paying by check, send payment to:
Chinese Health Center, Inc.
42104 N. Venture Drive, Suite 105
Anthem, AZ 85086
Or call (623) 551-3773 for additional information
Contact Information
 
Business Name/
License#:

Individual's Name

Address:
City: State: Zip:
Phone: Fax: Email:

Seminars

Select Seminar(s):
(check one or more)*:

Indicate seminar title

Call to verify cost

 date Professional
Fee		 Student
Fee

Payment Information

method of payment
(check one):

VISA MC check

Acct No.:

Exp. Date:

site last updated 02/20/05