Class Registration


Thank you for your interest in attending Energy Chiro I in San Diego, CA on June 23 - 25, 2017

Please make sure to fill in all fields and text boxes.

Full Name:

Email address:

Phone (including area code):

Address:

City/State/Zip: / /

Country:

Please tell us a little about your experience with Energy Medicine - have you studied any Eden Energy Medicine or any of Ellen Meredith's work ? (pre-requisite for this class is one year of EEM training or permission from the instructor):

What are your hopes or expectations for this class (if any)?

Are there any health, mobility, mental health, or learning issues we should be aware of?

Total Course Fee is $350 for new students; $175 for repeating students. A Deposit of $100, or Full Payment, due with registration. Payment of Total Course Fee is due June 23, 2017

Payment options (please select one, payment information will be provided on next page):
I wish to pay the full $350 New Student Fee.
I wish to pay the $100 Deposit.
I wish to pay by Check.
I wish to Request a Repeat Student Invoice

Additional details will be sent with confirmation of registration.

By submitting this form I certifiy that all the information is accurate.

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