Beginning Course Advanced Course (Circle one)
Name_______________________________________________________
Address______________________________________________________
City____________________________ State_________ Zip______________
Phone Home.___________________ Work__________________ E mail_______________________
Full payment required with application Amount $___________ $650.00 before 8/15/02 $750.00 after 8/15/02
Check Cash Money Order (Circle one).
Mail to:
Kodenkan Restoration Therapy
20364 Town Center Lane # 12E
Cupertino, Ca. 95014