CLEANSE REGISTRATION - FALL 2009
CLIENT REGISTRATION
Please fill out completely
Program Dates and Times
Friday 6/4, Friday 6/11, Wednesday 6/16, and Monday 6/21, 6:30-8pm
Tuition
$325; Early Bird Special $275 if registered by 5/28/10!
$250 for cleanse repeaters.
Name:
Gender: Date of Birth:
Gender: Date of Birth:Address:
E-mail:Phone:
Phone: How did you hear about the Cleanse?
Payment Method:
Ying Yu, MS, CNGreen Lake Nutrition6329 20th Ave NeSeattle, WA 98115I understand that I am financially responsible for the full cost of this program and agree to pay for services. I understand that I will not be refunded any portion of the tuition once the program has begun.
Ying Yu, MS, CN, CHHC
