or fax to 636-282-9517 or mail to address below with you check!

http://www.MotherEarthPillows.com/PillossageClassPayment.html
This link will take you to our Parent Website for a Secure Payment online option

mail to:                   MEDINC Education
Mother Earth Designs, Inc
2085 Jennemann Lane
Arnold, MO   63010

All registrations must be submitted and completed through Mother Earth Designs, Inc in Arnold, MO.  We regret that reservations cannot be held without payment.

Must take each Pillossage™ class in sequence

Discount 10% for repeating any class

Deadline for class registration is 7 days prior to class scheduled so adequate materials and products required for class are available.

Class sizes may be limited due to location constraints and/or number of prior registrants.  To assure reservation, please call early. 

Register 30 days prior to class to save $25 (LEVEL 1 $330 / LEVEL 2 $370

Cancellation Policy  In the event that you are unable to attend your scheduled event, all tuition payments are transferable to any course up to one year from the original course day or you may send a substitute. 

Products Used in Class will be Provided

According to Universal Precautions, we adhere to the policy that all pillows used within the class setting will be unused products that are opened at the onset of class. The cost of Mother Earth Pillows® used as tools will be included in each class cost.

First Name ______________________________    

Last Name __________________________________  

Address _______________________________________________________________

City ______________________________ 

State _______ 

Zip ____________________

Phone # office or land______________________________

Phone # cell _________________________________

Business name if applicable _______________________________________________

Email address  
______________________________________________________

Url: ___________________________________________________________________ 

Paying by:          
_____ Credit card  
CC#____________________________________________________
    Exp date _______________       CV# on back __________  (3 digits)   
_____ Check   #______________
_____ Money order
_____ Other _______________________________________

_____ LEVEL 1   $355   16 CE’s   includes Pillossage™ Level 1 Pillow Set / value $94
                (Body Wrap, Small Bolster & Sinus Pillow)    

_____ LEVEL 2   $395   16 CE’s   includes Pillossage™ Level 2 Pillow Set value $162
                                (Shoulder Triggerpoint Pillow™, Small Flax, Large Flax & SPABoots™)      

Location ___________________________________________________

Date  of class   __________________________

NCTMB # ____________________    

State Professional License # _______________________

Signature ______________________________________________________________
mail to:
                Pillossage™
                Mother Earth Designs, Inc
                2085 Jennemann Lane   
                Arnold, MO  63010