Level 1 Registration – Core Movement Integration Training Institute

Name

Address

Cell phone

Home phone

Work phone

Professional specialty

Intention and Outcomes:
What do you want to do, achieve, realize by taking this 100 hour program

Are you experiencing body issues that might be addressed and resolved in this 100 hour training program?

With this deposit of $300 and a non-refundable registration fee of $100, I declare my intention to join and receive the full benefits of the CMI 100 hour program as described in the document Core Movement Integration Practitioner Certification Program Level 1 - 100 hours. During my course of study my deposit will remain intact and will be applied to the final 10 hours of my course of study. If for any reason I decide to discontinue the program, I will give 30 days written notice. My $200 deposit will be refunded less any outstanding payments due.