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.
Phone (including area code):
City/State/Zip: / /
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
Please specify the city where you attended a Energy Chiro live weekend class with Ellen Meredith:
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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