Class/ Workshop Registration Form

Using your browser, you can send this page by e-mail to  , complete the form from your e-mail program, then send payment by regular mail. 
Alternately you can print out, complete and post with cheque or money order to the address at bottom of form .  Payment can also be made with Visa/MasterCard/American Express/Diners Club.  Simply advise of this choice and we will call you on receipt of your Registration Form.

Name: ______________________________________

Address: ____________________________________

City/ Prov. / Postal Code ________________________________

Phone: Home: _________________

Work: _________________

Cell: _________________

e-mail: ______________________________

How did you hear about the course for which you are registering? ___________________________________

I wish to register for: (All fees are in $CDN

_____  Create Healthy Boundaries - Lovingly Say "No".   $150 + GST ($105.00)

_____  Oh My Aching Back ... $75 + GST

_____  Introduction to Hawaiian Huna Kane $500 & GST

_____  Foundations of Hawaiian Huna Kane $1200 & GST

_____  BodyMapping of Hawaiian Huna Kane$1200 & GST

_____  High Altaring of Hawaiian Huna Kane $500 & GST

_____ FREE Introduction to Psychosomatic Therapy

_____  Psychosomatic Therapy Certificate III      Level I & II -  $3,750 + GST

Level I -

Unit 1  -  Psychosomatic Breakthrough 

Unit 2 - Psychosomatic Therapy:  The Art of Reading Faces

Unit 3 - Psychosomatic Therapy:  Body-Mind Analysis 

Unit 4 - Psychosomatic Therapy:  The Language of the Hands

 Level II -

Unit 5 - Psychosomatic Therapy:  Emotional Anatomy

Unit 6 - Psychosomatic Therapy:  Certificate III

Total of Courses selected:  $___________

Please make cheques/ money orders payable to MML Consulting and send to:

Monique Dorge

236 Lanark St.

Winnipeg, MB, R3N 1L2

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