ASHA School of Massage Atlanta

Continuing Education

Application Form

wholepersonhealthcare.org
326 Washington Street Annex, Wellesley, Ma 02481
Tel: 781-237-7971 Toll Free: 1-888-354-4325
Fax: 781-431-0017

Name:

Application Date:

Address:

Phone:

(home)

(cell)

(work)

(fax)

Email Address:

Date of Birth:

Present Occupation:

How did you hear about the program?:

Education History:

Payment Method:

Credit card Type:

Card Number:

cvv:

Expiration:

Amount Charged: $

Payment Choice:

# of Months:

Total: $

NOTES:

ASHA School of Massage is an institution accredited by the Commission on Massage Therapy Accreditation (COMTA).

For more information visit:

Application Form