Primal Hints  

Course Registration Form

Please Print, Complete and Send

Name: __________________________________________________________

 Phone Number: __________________________

Address: ________________________________________________________________

                   Number              Street                       City                State                     Zip

Email:______________________________________________________________-

Course Name and Date for Which You Are Registering:

 ____________________________________________________________________

 Please Select For Contact Hour Classes Only:

 RN ______     Massage Therapist __________( please include license number)    Other  ____________________

All Cone Employees for Contact Hour Courses Only :

Department: _______________________________  

Employee ID Number ______________________

Credit Card Customers

Credit Card Number: __________________________________________________

Expiration Date: ______________________

Signature: _______________________________________________________________

Please send your check or credit card information along with this form to:

Primal Hints

4909 Lonita Street

Greensboro, NC 27407

Or  call 

336-292-6846 to Register

Thank you for choosing Primal Hints !