Home >> Registration Form for Ursa Classes
Registration Form for Ursa Classes
Tuition
- 2 1/2 day class $600 - 18 contact hours
Sacramento CA - 2 1/2 day class $900 - 18 contact hours
Edmonds WA - 2 1/2 day class $700 - 18 contact hours
Reno NV
All enrollees must
possess the statutory authority by Licensing, Registration or
Certification to apply the techniques learned.
DO MD PT OT LMT LMP ATC PTA PA DC DDS ND RN
Osteopathic Physicians, Medical Doctors, Physical Therapist, Occupational
Therapist, Licensed massage Therapist/Practitioners, Athletic Trainers,
Physical Therapy Assistants, Physician Assistants, Chiropractors,
Dentists, Nurses, and others that have the statutory authority to apply
the techniques learned.
Printer-friendly Form
Ursa Foundation
P.O. Box 1447
Edmonds, WA 98020-1447
(206) 546-3676
Registration Form
Name:_______________________________________________________
Profession (Circle) DO MD
PT OT LMT LMP ATC PTA PA DC
DDS ND RN
Other _________
License or Registration #____________________________
Work Address:_______________________________________________________
Home Address:________________________________________________________
_______________________________________________________________
_______________________________________________________________
Phone:_(
)_________________________________________
Email_________________________________
Address__________________________
WORK: ( )
_____________ FAX ( )____________________
HOME: ( )______________
HOME FAX ( )______________
Course Title:______________________________________________________
Course Date:______________________________________________________
Course Location___________________________________________________
Deposit ______________
$100.00
non-refundable/non-transferable
deposit is required to reserve a place on the class.
A deposit of $100. is required to hold a place on each class.
The deposit is non-refundable/non-transferable. The tuition balance
is due one month prior to the course date. Make your check payable
to Ursa Foundation and mail with your registration to PO Box 1447,
Edmonds, WA 98022 - 1477.
We do not accept credit cards.