Makoto Kai Healing Arts
Massage Course Pre-Registration

Print this out and mail with a check for $75 to:
Makoto Kai
443 First Street
Woodland, CA 95695

PRINT CLEARLY

NAME ________________________________

ADDRESS ________________________________     
                  number  street

                __________________________________________________                      
                  city  state  zip

PHONE (_____)__________________                                                                              
E-Mail _________________________ 

Pre-register me for the Massage Course at Makoto Kai.
Name of the course:______________________________________
Start Date:______________________

"I understand that the $75 pre-registration fee is non-refundable if I am accepted into the program.
I also understand that the balance for the course is $1,174, which includes AJJF membership."


SIGNATURE __________________________________________________      

DATE___________________________

AJJF membership # _______________
Expiration Date        _______________
OR     I will apply:    _______________ 

PDF version of the Pre-registration Form