level 1 RESIDENTIAL APPLICATION

SUMMER PPN INTENSIVE with myrna martin

July 6 - 17, 2020 In Bellingham, WA or

July 20 - 31, 2020 In Bellingham, WA

Name

First Name

Last Name

Primary Phone Number

Email Address

Mailing Address

Current Occupation and Years in Practice

How Did You Hear About this Residential Intensive?

What is Your Purpose for Taking this Intensive?

Do you have difficulty walking on uneven ground?

This is important to know for determining where you will reside on the property.

Yes

No

May We Share Your Contact Information with Your Cohort to Assist with Arranging Travel?

Yes

No

Is This Your First Time Working with Myrna or Are You a Returnee?

FIRST TIME - (Please fill out and submit the "LONG FORM" found below.)

RETURNEE - (Please fill out and submit the "SHORT FORM" found below.)

Session Date

Select session you are applying for

PAYMENT INSTRUCTIONS

Please send your deposit of $500 to reserve your space.
The remainder of the tuition ($1,180.75) will be due one month before class begins.
Make cheques or money orders payable to Myrna Martin.
Send bank etransfers to myrna@myrnamartin.net
Click here for details about food and accommodations.
Visa and MasterCard also accepted through PAYPAL Additional fees may apply.

Please call or email Myrna Martin for more details.

personal photo needed

Finally, please upload and email a recent photo of yourself to Myrna at: myrna@myrnamartin.net

Include your name and the Workshop Dates you are applying for.