TMR Seminars - Enrollment Form

Please use this form ONLY When You Have Purchased TMR COURSES (TMR-1, TMR-2, TMR-3, TMR-4, TMR-5, TMR-6, TMR-7)

First Name *

Last Name *

Credentials *

Email You Purchased With *

Cell # *

From Where Did You Come To Know About The Course *

Has The Course Been Purchased By Your Clinic Owner (Clinic Staff Package) ? (If Yes, please provide your Owner Name & Clinic Name For Reference)

Have Your Taken this Course Before? *

Seminar Level You Want To Start: (TMR-1 / TMR-2 / TMR-3 / TMR-4 / TMR-5 / TMR-6 / TMR-7) *

Live-Online Or Homestudy? *

Live Online Can Count As Live Credit Except For MTs

For Live-online, please put Seminar Date. For Homestudy, please put start date *

Professional Lic # and State *

State
Professional Lic #