Application & Registration - Reflexology (foot) Step 1: Choose the workshop you wish to takeProduct Name*MAY 22-23 Venice, FLStep 2: Complete your registration profileThis information is needed to create your certificate, post credits to the professional agencies that require such information from the provider, and to contact you, if necessary. Rest assured - we do not share such information. ALL FIELDS ARE REQUIRED.Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email* Phone*Emergency Contact Phone*Emergency Contact Name* First Last Relationship* How did you hear about this training?*Please be specific and name as many sources as are applicable.Do you require continuing education credits?* No Yes Professional License* Alpha/Numerical # State / Province / Region ARCB Certification #ARCB (National Reflexology) NCB Certification #NCB (National Massage): Refund Policy*A significant amount of non-refundable monies was paid by the Academy when scheduling this training event for you, and for that reason, we must enforce a strict refund policy, to which you agree when registering. * Refunds, minus a $75 cancellation fee, will be issued to those individuals needing to cancel 10 days in advance of a class or workshop. * Anyone needing to cancel nine days or less before the class or workshop will receive a credit for the amount paid that may be redeemed for a future training, products, and/or clinical services or business consultations from Karen Ball, Academy director. * Notice to cancel attendance must be in writing (email), not by telephone. * No refunds or credits will be issued to ‘no-shows.’ * In the unlikely event that a course is cancelled due to unforeseen circumstances, the event will be rescheduled at the earliest possible date. A full refund will be issued if you are unable to attend the new date. * Refunds due will be issued within seven business days. Refunds will be issued back to the payment source used to purchase the event ticket. I agree to the refund policy Sign up for the Academy's newsletter?* Yes No Step 3: Please ensure the information above is accurate before proceeding.After you have checked to make sure all the above information is accurate, please submit your application by pressing the "Next" button below. Your application will be complete once the application fee payment is approved by your credit card company. PAYMENT MUST ACCOMPANY THIS APPLICATION IN ORDER TO RESERVE YOUR SEAT IN THE CLASS.Total $0.00 Credit Card Cardholder Name Card Details Δ