Tao of Trauma Seasonal Case Consultation Group Registration

Name*

Email*

We have been having problems with certain email providers, including Yahoo and AOL. If your primary email is with YAHOO or AOL, please also leave an alternate email below.

Alternate Email

For YAHOO and AOL users

Phone Number*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

I am licensed as a:*

For NCCAOM PDAs

Please provide your State Acupuncture license #, NCCAOM #, and date of birth if you would like NCCAOM PDAs

2023-24 Virtual Cohort student?

Please check this box if you attended the WOOD MODULE with the Virtual Cohort. Fees for the Wood Seasonal Case Consult group session will be $0.

2023-24 Virtual Cohort student

I am registering for:

Included as part of Virtual Cohort student tuition

April 19, 2024 – ToT Case Consult – Wood ($0)

BIPOC, LGBTQ+, or First-Generation Immigrant?

In the spirit of cultural transformation through healing, if you are BIPOC, LGBTQ+, or a first-generation immigrant, please check this box to receive 25% off fees.

BIPOC, LGBTQ+, or first-generation immigrant

I am registering for:

April 19, 2024 – ToT Case Consult – Wood ($50)
June 7, 2024 – ToT Case Consult – Fire ($50)
September 13, 2024 – ToT Case Consult – Earth ($50)
Other (enter amount in Other Payment Amount field below)

I am registering for:

Fees reflect 25% discount

April 19, 2024 – ToT Case Consult – Wood ($37.50)
June 7, 2024 – ToT Case Consult – Fire ($37.50)
September 13, 2024 – ToT Case Consult – Earth ($37.50)
Other (enter amount in Other Payment Amount field below)

Other Payment Amount

Enter other (if any) payment amount here.

Payment Method*

Checks should be made payable to "Integrative Healing, LLC" and mailed to Integrative Healing, LLC, PO Box 204, Hyattsville, MD 20781. Receipt of your fee will hold your space.

Credit Card
Check
N/A (Virtual Student: no fees due)

Total

$0.00

Credit Card

Card Details

Cardholder Name

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