Registration Registration RequestWhen you have completed the form please click the submit button, located at the bottom of the form.Your Name:*Phone: Area Code - Phone Number Course:*(Select a Topic)Polarity Therapy 101 - IntroductionPolarity Therapy 201 - Level 1Polarity Therapy 301 - Level 2EDU-K 101 - Brain GymEDU-K 110 - Brain Gym for EducatorsEDU-K 105 - Double Doodle PlayEDU-K 102 - Whole Brain LearningEDU-K 201 - Optimal Brain LearningEDU-K 220 - Vision CirclesEDU-K 221 - Movement Exploration 1EDU-K 222 - Movement Exploration 2EDU-K 301 - In DepthEDU-K 360 - Creative VisionEDU-K 350 - Movement Re-EducationEDU-K 311 - Total Core RepatterningEDU-K - Rhythmic Movement 1EDU-K - Rhythmic Movement 2EDU-K 400 - Teacher PracticumEDU-K 410 - Language MovementEDU-K 505 - Double Doodle Teacher TrainingTouch for Health 1 & 2Touch for Health 3 & 4Touch for Health Teacher TrainingSynergy Level 1Synergy Level 2Synergy Level 3Synergy Level 4Workshop - Anatomy & PhysiologyWorkshop - Business - Manifesting, Developing, Attaining easilyWorkshop - Cranial IntroductionWorkshop - Crystals, Elixirs, MeditationWorkshop - Understanding the BrainWorkshop - Understanding & working with DisabilitiesWorkshop - Working with SeniorsAdditonal Comments:E-mail:*Address: Street AddressStreet Address Line 2CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiComorosCongo (Brazzaville)CongoCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMoroccoMozambiqueMyanmarNamibiaNauruNepaNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabweCountryWhen is the best time to contact you:MorningAfternoonEveningSend a copy of this message to yourself: SubmitReset