Registration Form - The Center For Healing
The Center For Healing
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Achieving Adulthood Class
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Diversity Education
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About Germaine Smith
EMAIL REGISTRATION TO:
[email protected]
Name
Addr
ess
City
state & Zip
Phone
Email _________________________________________________
CALCULATE COST checks payable to Germaine Smith
your gross hourly wage _____ ____ x 6 = $ __________ cost for Level One
Minimum of $10 per hour = $ 60 for Level One
Missed cases may be made up by an additional session;
cost for additional session is an additional gross hourly rate.