level 3 Non - RESIDENTIAL APPLICATION

PPN INTENSIVE with MYRNA MARTIN

oct 18-29, 2021 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 Intention 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.)

PAYMENT INSTRUCTIONS

Please submit a deposit of $500 USD to reserve your space
The remainder of the tuition ($1,300 USD) will be due one month before class begins
Make cheques or money orders payable to Myrna Martin
Send bank etransfers to myrna@myrnamartin.net
Visa and MasterCard also accepted through PAYPAL 3% processing fee will 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.