Acutonics® Registration Form
To register please print out this page, complete and mail to: Susan B. Goldstone, L.Ac
Center for Oriental & Harmonic Medicine
301 Brookstown Ave., Suite 500
Winston Salem, NC 27101
Make checks payable to: Center for Oriental & Harmonic Medicine. You may also call (336) 760-3993 to register with Visa or MasterCard. Email your registration information to sgoldstone@triad.rr.com.
Please note: this email address is not secure. You may not want to email your credit card information.
Please Choose Below
|
Acutonics®I: Sound Gates to Meridian Harmonics _______
|
Acutonics®II: Higher Harmonics and the Inner Nature of Tone ________
|
Acutonics® III: Harmonic Attunement _____
|
Acutonics® IV: Advanced Harmonic Applications ______
|
|
Acutonics®: Energetics of Points and Meridians _______
|
Acutonics® VI: Case Studies, Clinical Documentaries ________
|
Acutonics® VII: Harmonic Pathology _________
|
Acutonics® VIII: Thesis_________
|
|
Acutonics® I & II Intensive_______
|
Acutonics® III & IV Intensive_______
|
Class Dates:___________________________________
Name:________________________________________
Address:______________________________________
Email Address:_________________________________
Payment (circle one): Check MasterCard Visa
Credit Card Number_______________________________
Expiration Date:______________Amount of Payment $_____________
CCV(3 digit security code on back of card)____________
_____I would like to purchase the book and/or forks from you prior to seminar
_____I will wait to purchase the book and forks at the seminar
_____Undecided
|