Alexander Technique Registration 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 Session(s) (select all that apply)(required) Fall Winter Spring Preferred Start Date How did you hear about us? (ie: flier, web search, word of mouth)(required) 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
