D.N.F.T. Seminars - On-line Sign-Up Form

Comments:

Seminar Registration Form There are three ways to sign up. For fastest processing, fill out this form online and click on the "SignUp" button at the bottom Print this page and fax it to 310.657.2279 Print this page and mail it with a check to the address listed below.
Name:
I am a:	DC Student
With regard to D.N.F.T. Seminars, I am:	New - first time to a D.N.F.T. Seminar Reviewer - attended another D.N.F.T. Seminar
State License Number:
Chiropractic School Graduated from or Attending:
Seminar Location:
Seminar Type	Full Spine Extremities Cervical and Thoracic Lumbar and Thoracic Motor Skills Intensive Mini-Intro / Intro to D.N.F.T.
Seminar Date:
E-Mail Address:
Street Address:
City:
State:
Zip Code:
Home Phone:
Work Phone:
Fax:
Course Fee for Seminar:
Please charge my:	VISA Mastercard American Express Discover
Card Number:
CVV (Security) Number (last 3 digits on back of card)
Expiration Date: (MM/YY)
Please note: cancellation fee 1) Cancelling with less than 2 weeks notification before seminar: $100-DC, $25-Students 2) Cancelling after signup: 10% of seminar course fee (for processing expenses) For Annual Advanced Seminars, cancellations fees are published separately. If payment is made at the door (at the seminar), then add $25.

Seminars Menu \| Schedule \| Registration {Site Index }{ Dr. John }{ Dr. Van Rumpt }{ Doctor Referral List } {D.N.F.T. Seminars }{ Equipment }{ D.N.F.T. Home Page} D.N.F.T. Seminars^Ž \| 239 S La Cienega Blvd, Suite 203 Beverly Hills, CA 90211 v:310.657.2338 \| f:310.657.2279 \| dnft@nonforce.com ŠMMIX