Registration Form

Please print the following form and mail it to us. Thank you.

To download a copy of registration form in Microsoft Word format, please click here.

Nordblom American Institute of FootZonology®
178 Mill Creek Road
Livingston, MT 59047
U.S.A.
Phone: (406) 333-4216
Fax: (406) 333-4415
e-mail: KNordblom@aol.com


Name: ___________________________ Date: ____________

Address: __________________________________________

Phone: (home): _________________ (work) ______________

I would like to register for the following seminars:
	FootZonology® 1 ZoneBalance / ZoneAnalysis Date:___________________ Location:__________________________________
	Class: _________________________________________________________________ Date:___________________ Location:__________________________________
	Registration Fee: $100 (registration fees are deducted from the tuition)
	Please send me the schedule for the following classes: _____________________ _________________________________________________________________
Attach a brief summary of your background and interests and your reasons why you desire to become a FootZonologist.
Make your check or money order payable to: Nordblom American Institute of FootZonology®