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BIODYNAMICS PROGRAM - COURSE REGISTRATION FORM

Click here to print the registration form and send it to: Marnee Jealous Long / Longtide Management Inc. / 6501 Blackfin Way / Apollo Beach, FL 33572, or fax it to 813-649-0760.

To register for a course offering complete the information below and return with payment by the registration deadline date. The course fee is $650.00. Registration is on a first-come/first-serve basis. (One form per course registration please.)


Name:
Degree Title:		AOA#:
Address:
City:		State:
Country:		Postal Code:
Phone:		Fax:
E-Mail:
College of Graduation(name and address)

Yr of Graduation:		Type of Practice:
Prior training in the Osteopathy/Cranial Field(s) including any Biodynamics Courses you have completed:

Phase(s) Desired:		Date:
Instructor:		Location:
Have you taken this Phase before?		Payment: $

**If you are interestd in a course that is “closed” and would like to be put on our waiting list, please contact us and we will be glad to put you on our waiting list.

Payment Information: Check or money order made payable to James S. Jealous, D.O. No postdated checks, please. We are unable to accept credit cards. A fee of $35.00 will be charged on all returned checks. CANCELLATION POLICY: There will be a $250.00 cancellation fee for cancellations made 14 days or less prior to a course.

Send Payment and Registration Form by the deadline date to:
Marnee Jealous Long
Longtide Management Inc.
6501 Blackfin Way
Apollo Beach, FL 33572
(813) 649-0708 phone or (813) 649-0760 Fax
mjllong@verizon.net

Dr. Jealous reserves the right at any time to deny an individuals request for course enrollment and/or attendance to the course.

Copyright © 2006 Direction of Ease, LLC (d/b/a James Jealous D.O) • All Rights Reserved
The material on the website is property of Direction of Ease, LLC (d/b/a James Jealous D.O.), and cannot be copied, edited, or reproduced in any manner whatsoever without the explicit permission of Direction of Ease, LLC (d/b/a James Jealous D.O).

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