Discover the Myofunctional Therapy Puzzle

"Discover the Myofunctional Therapy Puzzle" Professional Training Course

Official Registration Form for 3-Day Professional Training Course. Upon completion of this 3-day course you will receive verification of training, and will qualify you for IAOM certification. If you have questions regarding this form, payment, or the course - please email PAT at info@musclesinharmony.com

This field is for validation purposes and should be left unchanged.

First Name(Required)

Last Name(Required)

E-mail(Required)

Phone Number(Required)

Please select locations and dates(Required)

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

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

Emergency Contact Name

First Last

Emergency Contact Phone

Food Allergies?(Required)

Why are you interested in this course?(Required)

Payment of the $3,000 course fee is due at time of registration. Your registration is not complete until payment has been received.(Required)

Accepted forms of payment include: payment via Zelle to PAT PINE at 847-207-7463 with no additional fees, personal check or certified check paid immediately after registration within 5 days of registration. *Contact Pat if using personal check*

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I am a licensed professional registering for a 4-day 30-hour course on "Discovering the Myofunctional Therapy Puzzle."(Required)

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Signature(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 in Harmony / (847) 207 -7463