Alexander Technique Registration Parent/Payor Name(required) E-mail Address(required) Phone Number(s)(required) Best Time to Call Mailing Address (include City, ST, Zip)(required) Student Name(required) Student Birthday(required) Beginner or Advanced?(required) Beginner Advanced Preferred Start Date Do you give permission for photos of the student to be used by HNMC for promotional posts and/or fliers? Yes No Electronic Signature of Person Responsible for Payment (Type Name) (required) Submit Δ Photo Consent About the class
