PRIVATE COURSE REGISTRATION

All information entered on this form is kept strictly confidential.

Name *
Name
Phone Number
Phone Number
Address *
Address
Date of Birth
Date of Birth
Are you currently under regular care of a medical doctor, psychologist, or psychiatrist? *
Do you sleep well? *
Make CHECKS payable to Arden Martin. Make VENMO payments to username Arden-Martin.
I understand that the course fee is non-refundable and due prior to the commencement of the course. If paying in installments, I understand I am obligated to make all payments.