Print this form and mail to DTP, Inc., Box 3083, Stony Creek, CT 06405-1683 USA
NAME
MAILING ADDRESS
PHONE
CURRENT JOB and/or AREA OF INTEREST
EDUCATIONAL BACKGROUND (degree/diploma/certificate, year, school/org)
I AM REGISTERING FOR -- LOCATION
DATES
BASIC PRE/POSTNATAL $265*_____ / 290**____
MENOPAUSE $60*____ / 75**____
BASIC & MENOPAUSE $315*____ / 355**____
RECOVERSIZE $50*____ / 65**____
UPDATE $80*____ / 80**____
*postmarked at least 6 weeks prior to your seminar
**postmarked less than 6 weeks prior to your seminar
--OR--
ARE YOU OR YOUR EMPLOYER APPLYING FOR A LICENSE? ___ YES ___ NO
BUSINESS NAME, MAILING ADDRESS and BUSINESS PHONE
CONTACT PERSON
DTP T-SHIRT $20____ ($5 for Pediatric AIDS Care)
TOTAL $_____________ CHECK (to DTP, Inc.) ____ VISA ____ MASTERCARD ____
CREDIT CARD # __________________________________________EXPIRES_____/_____
CONTINUING EDUCATION CREDITS (check):
ACE _____ ACSM _____ NSCA _____ ACNM _____ ICEA _____ AWHONN _____ OTHER _____
For more information, send e-mail to:
Ann Cowlin / ann.cowlin@yale.edu
Fill out our comment form:
Or send mail to:
Dancing Thru Pregnancy, Inc. / Box 3083 Stony Creek, CT 06405 / 1-800-442-9034