Price: $5.00 per copy
Document type: Copy of Continuing Education Course Certificate
Number of copies:*
Student Name:*
Course Name:* (Example: Thai Massage 2)
Course Date:* (Example: September 2010)
Instructor Name:
Mailing Address:*
City / State / Zip:*
Day time phone:*
Last 4 digits of your Social Security number:*
Are you a graduate of ASM/AIA? Yes     No
Are you working as a massage therapist or esthetician? Yes     No
Are you an employee of a company or are you self employed? Employee     Self Employed     Not Employed
If you are employed, who is your employer?