***Application must be received 2 weeks prior to training dates selected***

For those wanting to attend the Special Population day-long session following June Intermediate Teacher Training week, please indicate your intention and enclose fee of $100.00 with this application.

ONLY THOSE WHO HAVE ATTENDED a RETRAINING ARE ELIGIBLE to APPLY for the INTERMEDIATE TEACHER TRAINING.

  NAME_____________________________________PHONE(______)-______-________    M___   F___

  MAILING ADDRESS___________________________________ email ___________________________

                                      _____________________________, _________ ZIP______________

  Indicate your present work with BODY RECALL__________________________________________________________________

  _________________________________________________________________________________________________________ 
                                                                                         (Use back of printed page if needed)

  *************************************************************************  

Double or single occupancy*_______________Roommate____________________________

Date of arrival ____________________Approximate time_________________

     Traveling by car_____   bus_____   air _____ ?

Need for shuttle service from Lexington Airport ($35.00 round trip)?__________

    Arrival time______________Airlines and Flight #__________________

    Departure time____________Airlines and Flight #__________________

  *The workshop fee of $500.00 for 5 nights and 5 days is based on double-occupancy unless you indicate otherwise.  Single-occupancy may be requested at an additional charge.  A non-refundable deposit of $100.00 must accompany this application.  The balance of $400.00 will be due on or before registration.    

                                                                                               
                                                                                                          Signed__________________________________

MAKE CHECKS PAYABLE TO and MAIL TO:   BODY RECALL, INC.