All fields marked with an asterisk (*) are required. To ensure accurate processing,
                                        please do not use symbols (such as & - / #) in your address.

* Today's Date: 2009
* Training Date Requested: 2009
* Location Requested :
* Name (first and last) :
* E-mail Address :
* Home Phone Number :
* Work Phone Number :
* Current Address :
* City / Town :
* Province / State :
* Postal Code / Zip :
* Relevant work experience,
  describe briefly:

  (you may e-mail your CV)

* I would like to teach Infant
   Massage because:

  (you may e-mail a separate   sheet)   
* please check appropriate   boxes if you require:
   		 Meals     Yes     No

Lodging  Yes     No

Transportation  Yes     No

Tuition is $ 550.00 CND payable in advance. Tuition includes: 3 day program, your Instructor Teaching Guide, one required book and your CIMI® certificate. Please submit registration form as well as one letter of recommendation, from someone who knows you well, dated within the last year. Please make cheque/money order payable to "Jill Vyse". Mail complete packet to:
6501 A Bilberry Drive, Ottawa, ON K1C 4N4.

                                 2009 - space is limited.