Body and Soul Theraputic Massage School :: Wichita's Body & Soul Massage Center

Body and Soul Theraputic Massage School Online Workshop Application Form
	* Please note: all fields are required
Last name:
First name:
Address:
City:
State:
Zip:
Home phone:
Work phone:
Email address:
Date of birth:	/ /
	Male Female
Emergency contact:
Phone:
Relationship:

Educational Background

Please list the name of the institution(s), date(s) attended, and degree/certificate


Massage and Bodywork Experience

Please list any past experience you have had with massage and / or bodywork. Please include the type of bodywork and number of years experience.


Name of workshop

* Payment options:
1. If you are paying by check, please mail to Body and Soul Theraputic Massage School 2. If you are paying by Visa or Mastercard, please call the school to run your credit card