Norton School of Lymphatic Therapy
Two-Week Full CDT Certification Course Registration Form
750 State Route 34 • Suite 7 • Matawan, NJ 07747
(866) 445-9674 Toll-Free • (866) 854-7800 Fax
DESIRED COURSE DATE AND LOCATION
Course Date: Course Location:
CONTACT INFORMATION
Name:   Business Name:  
Home Address:   Business Department:  
Home City, State & ZIP:   Business Address:  
Home Phone:   Business City, State & ZIP:  
Mobile Phone:   Business Phone:  
FAX:   E-Mail:  
PROFESSIONAL TITLE
PT   PTA   OT   OTA   RN   LPN/LVN/NP   MD   DO   ATC   DC   MT*   Other ____________
*Massage therapists from the U.S. must show proof of completion of a minimum 500 hour training program or be certified through the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB). Massage therapists from other countries must show proof of an equivalent international program.
REGISTRATION AND PAYMENT

The tuition for the course is $2,600. The Norton School can accept payment by check or credit card. A deposit of $500 is required at the time of registration and will hold your spot until the balance is received no later than two (2) weeks prior to the first day of class.

Please note that by submitting your registration you are accepting the Student Agreement as outlined on the Student Agreement page. Please indicate with your signature below that you have read the Student Agreement and agree to the terms as specified.
 
Signature: _______________________________      Date: ____________
 
To register, please mail or fax this registration form along with a $500 deposit paid by check or credit card and a copy of your professional license/diploma. Additionally, please select if you wish to receive the "Textbook of Lymphology" as outlined in the Student Agreement:
 
  Include the "Textbook of Lymphology" for an additional $100 (50% off the retail price) plus tuition bringing the required desposit to $600.
 
Payment Type:
Credit Card:     Mastercard     VISA     American Express     Discover
Card Holder's Name:                                
Account Number:                                
Exp. Date (MM/YY):                                
Check:     Made payable to "Norton School of Lymphatic Therapy"
Financial Aid:     (We will contact you to begin your application process.)
NOTE: If you are paying by credit card you may either include the information in the area above or call us to provide the information by phone.
TRAVEL AND ACCOMMODATIONS
Would you like to receive hotel information?     yes     no
Would you like to receive directions?     yes     no
Would you like to have your name and phone number given to other students for room sharing?     yes     no

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©2003-2008 Norton School of Lymphatic Therapy - A Division of The Norton Salas Group, Inc.