Your Name:

License # and State

A check here indicates that I have read and meet the pre-requisites for taking this course that are listed on the Frequently Asked Questions page: YES, I have read pre-requisites.

Your Email Address:

Your Address (Street):

Your Address (City,State):

Your Address (Zip Code):

Your Telephone Number (include area code):

Which Seminar? New York, NY - August 28, 29&30 Sarasota, FL - September 17, 18 & 19 Denver, CO - September 25 Denver, CO - October 1,2

Which do you prefer?
Telephone contact
Email contact

Which payment method will you be using?
Credit Card
Check (Accepted up to 10 days prior to seminar. After that payment is by credit card only.)

How did you hear bout Cosmetic Acupuncture Seminars?
From a colleague or frienda
From a newspaper or magazine article
Advertisement in Acupuncture Today
Through a mailer
Through a search on the web
Have attended a CAS seminar before

Thank you! We'll get back to you as soon as we can!