BIODYNAMICS PROGRAM - COURSE REGISTRATION FORM

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. 

To register for courses with Dr. Hankinson please refer to the course listing for the registration process for his courses (do not use this form).
   

First Name:
Last Name:
Degree Title:
Address:
City:		State:
Country:		Postal Code:
Phone:
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?
Please enter the required code listed below. If this form does not forward to me please return to this page and re-enter the code below.
Code:
Verify Code:

**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.

Marnee Jealous Long
Biodynamics Program Coordinator
6501 Blackfin Way
Apollo Beach, FL 33572
(813) 765-5005
mjllong@verizon.net


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