Seminar Registration Form

Yes, I would like to attend the Contact Reflex Analysis & Designed Clinical Nutrition seminar. Please reserve a space for me and others listed below. Either print out this page or click here to download a printable Adobe Acrobat PDF version of this page.

Note: CRA seminars are geared toward health care professionals with first professional degrees; however, they are open to all interested health practitioners.

Tuition:

Health Care Practitioners: $245 each per weekend
Accompanying Staff: $125 each

Registration form

Name(s):_________________________________Degree:_______________

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Address:________________________________________________________

City:_____________________________ State:_____Zip Code:___________

Phone:_________________________ E-mail address:___________________

Date & Location of Seminar:_______________________________________

Check Enclosed. (Make checks payable to CRA Education Resources)

Credit Card: (circle one)__________Visa_________Master Card

Credit card number:________________________ Expires:_______________

Mail this form to:
CRA Educational Resources
Dr. Paul A. Jaskoviak, Director
5625 County Road 7540
Lubbock, TX 79424

Telephone: (806) 863-5448
Fax: (806) 863-5449