Discover the Myofunctional Therapy Puzzle

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Last Name(Required)

Address(Required)

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Phone Number(Required)

E-mail(Required)

Please select your current professional credentials (mandatory to attend course).(Required)

RDH

DDS

SLP

Other

Emergency Contact with phone(Required)

Food Allergies or requests(Required)

Please Contact Us for Any Special Accommodation Needs

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What are your goals post-course?(Required)

Please select locations and dates(Required)

Payment of the $2,700 course fee is due at time of registration. Your registration is not complete until payment has been received.(Required)

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Accepted forms of payment include: payment via Zelle to Chase Bank at 847-207-7463 with no additional fees, personal check paid immediately after registration (must contact Pat if using personal check), or Payment via PayPal (please note that PayPal will include an additional fee that will be added to the total).

Printed Name

First Name Last Name

I understand, that I am a licensed professional registering for a 4-day 30-hour course on "Discovering the Myofunctional Therapy Puzzle." Please digitally sign:(Required)

Once You Finish Registration, Payment is Also Due

Thank you for registering. Finish by paying safely and securely

Pay by Zelle at Chase Bank at Muscles and Harmony / (847) 207 -7463

Additional 4% fee will be charged.