Recall Healing – Level 4 Course

Professors Gilbert Renaud, PhD & David Holt, D.O., HMD

COURSE REGISTRATION FORM

Course Contact Information Course Fees

Bill Gonseaux $390 /person if paid before Dec 5, 2008

bill@integramedacademy.com $490 /person if paid Dec 6, 2008 or after
Ph# 972.880.0888 Lunch provided both days
Mail: 3158 N. Lincoln Park Rd Each additional person from the same office
Van Alstyne, Texas 75495 will receive $100 off of full price. No credit
cards; mail check, cashier’s check, or money
order payable to: Wellspring

Registrant Information

Name & Title:

Names of additional attendees from your office:

Office Address:
City: State: Zip:
Office Phone: Mobile Phone:
Fax: Email:
Method of payment (please circle one): check cashier’s check money order
Please mail registration and payment to: IntegraMed Services
3158 N. Lincoln Park Rd.
Van Alstyne, Texas75495

***Lunch will be catered on Friday, Dec. 12 & Saturday, Dec 13. Please make arrangements for
all other meals and hotel reservations. Thank you!
Location Dates & Times
The Recording Studio Dec. 12, 2008 9-1 and 2-6
3158 N. Lincoln Park Rd. Dec. 13, 2008, 9-1 and 2-6
Van Alstyne, Texas