Equissage Colorado | Enrollment Application for Massage Therapy

Application

To complete this application online press submit after you are finished completing this. Then, on the application page of the website, make your deposit or payment in full.

E N R O L L M E N T A P P L I C A T I O N

PERSONAL INFORMATION

Date

Name

First

Last

Middle

Physical Address

Street

City

State

Zip Code

Cell Phone

Home Phone

Current Occupation

How did you hear about us?

Are you 18 years of age or older? Yes No

EDUCATION

	Name and Location of School	Last Year Completed	Did You Graduate?	Subjects Studied and Degrees Received

High School		1 2 3 4	Yes No

College		1 2 3 4	Yes No

Trade, Business or Correspondence School		1 2 3 4	Yes No

GENERAL Please limit responses to two lines. If you would like to provide more information, please do so on a separate document.

Subjects of special study or interest

Horse-related activities

REFERENCES List below three persons not related to you, whom you have known at least one year

Name	Address	Position	Yrs. Acquainted

ENROLLMENT AND PAYMENT INFORMATION

Please indicate which course you would like to attend, and the course dates.

5 Day ESMT Course - Tuition $1295/$300 deposit, starting //.

3 Day Advanced Workshop - Tuition $995/$300 deposit, starting //.

7 Day Combo Course - Tuition $2095/$600 deposit, starting //.

Both the ESMT course and the Advanced Workshop -
Tuitions $1295 + $895/ $600 deposit
(Reflects $100 discount on the advanced course) starting //.

Submission of the enrollment application along with your deposit will hold your space in the course you choose. If the course is full, you will be notified right away and asked to pick another date.

We ask that the balance of the tuition is paid no later than 2 weeks prior to the beginning of the class start date. If you need to change your class date for any reason, let us know in writing at least 2 weeks prior to the beginning of your class and we will move you to another class with no additional fee. If less than 2 weeks� notice is given, then you will be charged an additional deposit.

Please accept my enrollment in the Equissage Certification Program in Equine Massage Therapy.

Enclosed is my check or money order in the non-refundable amount of $300.00 to cover the deposit for the class, starting //.

Electronic Signature:

Equissage California | PO Box 2861, Valley Center, Ca. 92082
www.equissagecalifornia.com (760) 473-9893