Newsum Bio-Kinetics Health Restoration Seminars
P.O. Box 1237
Lomita, CA 90717

Print and Mail or Scan and Email Registration Form

Office Address:
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Graduate Of:
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Degree In: Year Received:
Techniques I have studied:

Therapies & Techniques I currently use in my practice:

I use these for analysis:
(Please check and/or describe where indicated)
Muscle Test: _____ Leg Length: _____ Arm Length: _____ O-Ring: _____
Other: _________________________ Other: _________________________

Course Date:
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Amount: (Check One)

Seminar Registration Fees:
First Time Attendee Seminar Fee includes manual, New-Stim Stimulator with holster, test and assessment charts: $575 _____
Refresher Seminar Fee includes manual: $175

Make checks payable to: Newsum Bio-Kinetics
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Learned of Seminar: ____ Referral ____ Print Ad ____ or _________________________

* Prices subject to change without notice.