Online Registration

This is  a secure formPlease use this secure form to register for seminars at the Therapeutic Massage and Training Center in Westfield New Jersey.
 

Refund/Cancellation Policy. A $50 processing fee is non-refundable.

Required fields marked *
   
  SEMINAR SELECTION
   
Seminars are $395. This form is for registering one person for one seminar. For 3 or more people registering for a seminar at the same time, contact Howard Rontal to receive a special volume discount of $50 each.
 
Seminar:*
 
 
 
 
Note: Please do not register for Part II if you haven't taken Part I yet.
   
  CONTACT INFORMATION
   
First Name:*
 
 
 
Last Name:*
 
 
 
Address:*
 
 
 
 
 
 
 
City:*
 
 
 
State:*
 
 
 
Zip Code:*
 
 
 
Email Address:*
 
 
 
Phone:*
 
 
 
  CREDIT CARD INFORMATION
     
Credit Card:*
 
 
 
Card Number:*
 
 
 
Expiration Date:*
 
  Month:
  Year
:
 
Card Authorization Code:*
 
 
 
 
 
  These are the digits found in the signature strip on back of your card to the right of the card number.
 
Name on Card:*
 
 
 
Billing Address:*
 
 
 
 
 
 
 
City:*
 
 
 
State:*
 
 
 
Zip/Postal Code:*
 
 
 
Country:*