Wellness Mentor Training: Registration Order Form

Wellness Mentor Training Registration Form

Please print this registration form and then mail, fax or phone in your registration to:

Human Resources Institute, LLC
151 Dunder Road, Burlington, Vermont 05401 USA
Phone: 802-862-8855, Fax: 802-862-6389
Email: Info@healthyculture.com

Product Name	Quantity	Price	Total
Wellness Mentor Training		$95.00
Payment Method A check is enclosed payable to Human Resources Institute, LLC VISA MASTERCARD
Name on Card	Exp. Date
Credit Card #	Phone #
Billing Address
Shipping Address (if different)
Email

Signature:_____________________________________ Date:_____________________________

Please send no payment if you are registering as member of a group or corporation. Name your sponsoring group or organization in space below and then complete the student contact information.

Sponsor/Organization Name ______________________________________________________

After your registration is processed, an instructor will send you an email with instructions for viewing the full Wellness Mentor Training website. Thank you!

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