REGISTRATION FORM   use your browser's back button to return to the site.

Thanks for your interest in the CranioSacral Therapy courses. Please use this registration form to reserve your place in the class or classes. You may mail this form with your check, or if you are using a credit card you may fax the form to Dr. Kalen. We will hold payment until the day the class begins. If you have to cancel notify us 48 hours before class and we can put you in the next class.

Please make sure we receive your registration at least two weeks prior to the course you wish to take so that course workbooks and materials can be ordered. I look forward to showing you the wonderful world of craniosacral therapy.

Registration Form       * fields below will appear in the Upledger Institute directory of practitioners

Name*   ____________________________________________________

Address ____________________________________________________

City*   _____________________________   State*  ________ Zip* __________

Phones - please indicate which one you want made public with an ( * )

        Home    (_____)________________ Work (______)__________________

        Cell    (______)________________

Email  ___________________________________@_______________________

Profession ____________________________________________

Class Registering for:

__  CST - I      Sept. 13 - 14, 2008     Weekend 8:30 - 5:00 both days   Cost $250.00

Method of payment               Make checks payable to Russ Kalen DC

__ Check __ Credit Card (MC or VISA only)     __ Debit card (MC or VISA)

Credit Card #   ______________________________________    Expires   _____/______

Three digit verification # (last three digits on back of card) __________

The billing address of the card must be the same as your address indicated above.

Mail to:        Russ Kalen, DC, CST             or Fax to:  (530) 899-8808

                244 West Ninth St.

                Chico, CA 95928-5522            Our phone (530) 899-8863