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Registration Form
Fax form to (321) 751-6111 or call (800) 558-2197 or (321) 751-7001
VISA, MasterCard, American Express, Check & Money Orders accepted

Make checks payable to:

Healing Light Seminars
279 N. Babcock St., Melbourne, FL  32935

Indicate seminar date you are registering for in space provided

____   Seminar $400, if payment is received
           30 days prior to seminar
____   $450.00 if paid thereafter

____   Students $200, if payment is received
           30 days prior to seminar
____   $225.00 if paid thereafter 
Discounts: 
  • $50.00 regular discount ____ $25.00 student discount ____ is granted to members of AAAOM, FSOMA and other state acupuncture/OM associations as well as to chiropractors, dentists, medical doctors, naturopaths, physical therapists, podiatrists or students of same with verified proof of membership to their respective national or state associations.
  • Two or more people signing up together receive $50.00 off each.
  • Two or more students signing up together receive $25 off each.

NOTE: Students must be enrolled in an accredited institution at time of registration. To receive discount for two persons registering together, both registrations must be submitted at the same time for the same seminar. Healing Light Seminars, grants a maximum discount of $100 for practitioners and $50 for student.

Name__________________________________Company_______________________________
 
Billing Addres_________________________________________________________________
 
City____________________________ State______________   Zip Code________________
 
Phone Number (______)______________________ Email_____________________________

Medical License held __________________Medical License # _____________ State ______

Seminar you are registering for: 

Date:_________________ City:________________________ State:________________

Payment:  ___Check ___VISA ___MasterCard ___American Express ___Money Order

Card#_______________________________ Exp Date_______________

Billing Address______________________________City________________________ST_____

Phone # affiliated with credit card________________________

Signature ____________________________________________

Cancellation Policy:

100% of course fee less $25.00 will be refunded for seminar reservations if cancellation is received in writing 30 days prior to the seminar date.

© 2004-2007 Healing Light Seminars, Inc
279 N. Babcock St.
Melbourne, FL 32935
800 558-2197 Toll Free
321 751-7001 Of.
321 751-6111 Fax