100-Hour Applied Kinesiology Course Registration Form
Seminar Location:
Southwest College of Naturopathic Medicine
2140 E Broadway Road Tempe, AZ 85282
Seminar Dates:
All Dates and Locations are subject to change
Session 1: October 24-25 Session 5: February 27-28
Session 2: November 21-22 Session 6: April 16-17
Session 3: December 5-6 Session 7: June 4-5
Session 4: January 23-24
Cost for Students/Doctors:
Student: • $210 per session if paid Per Session • $260 if paid at door
• $1260 if all sessions are paid by 11/1/14 • $1310 if all sessions are paid at door
Doctor: • $360 per session if paid per Session • $410 if paid at door
• $2160 if all sessions are paid by11/1/14 • $2210 if all sessions are paid at door
Name(Print):______
Billing Address:______
City:______State:_____ Zip:______
Phone:______
Email:______
Indicate Session Attending: All___ #1___ #2___ #3___ #4___ #5___ #6___ #7___
Visa/MC#______Exp:_____/_____ CVV:____
Check #______DL# & State:______Amount Paid:______
Important: Terms of Enrollment, by signing you agree to the following terms.
Cancellation Policy: A full refund (minus any credit card processing fees (10%)will be givenonlyfor cancellations made before the start of the first seminar date. A partial refund will be given forcancellations made by the end of Session 1 (Partial refund = full refund minus full cost of the firstseminar - 10%). No refunds will be given after Session 1. No exceptions.
Partial refunds willnotbe granted for partial attendance. No exceptions.
No video or audio recording equipment is permitted at any of the modules.
Any persons found to be selling or profiting in any way from the sale of notes, audio or video recordingsof Dr. Gregor and/or Dr. Murczek, without expressed written permission from Dr. Gregor and/or Dr. Murczek, will be dismissed from the program andprosecuted to the fullest extent of the law. Dr. Murczek reserves all rights of admission.
Every attempt is made to offer this program as announced. Dr. Murczek reserves the right, however, toadjust program faculty, location, dates, times and tuition to accommodate unanticipated occurrences. Dr. Murczek is not responsible for any expenses incurred by registrants due to program adjustments orcancellations. A professional code of conduct shall be maintained, you are contributing to an effort to keep fees lowand the overall educational environment one of constructive cooperation and professionalism.
Instruction of material outside the scope of the seminar during seminar hours is prohibited.
Signature:______Date:______