TFT Levels I & II package ........... $400.00 (two day course)
date (mm/dd/yy) from schedule
location from schedule

name **
degree or position **
** (these fields will be printed as shown on course certificate)
company
address
city state
zip/postal code
country
work phone
home phone
E-mail address


Completely fill out this form and print to mail with check or money order to:

Quantum Performance Institute
8919 Fleetwing Avenue
Los Angeles, CA 90045