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Jodi Pendry
Registered Massage Therapist
Certified Equine Sports Massage Therapist
HillErin Farm
R.R. #2
Hillsburgh, ON
N0B 1Z0
PH: 519-855-4447
jodipendry@sympatico.ca
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Registration Form
Name: ________________________________________________
Address: ______________________________________________
City: ______________________ Prov: _________ P.C. _________
Phone: (Home) _______________ (Work) ____________________
Horse Experience:
 Yes
No
Massage Experience:
Yes
No
Course Date of Interest: __________________________________
__________________________________
A deposit of $100 is required.
4 days @ $550
(+G.S.T.)
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Paid
in Full
Cheque Enclosed
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Deposit @ $100
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Deposit enclosed
only
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TOTAL
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Method of Payment: Cheque
Money Order
Deposit enclosed
only $100.00
Payment Enclosed
in full $550.00 + G.S.T.
In need of
Overnight Accomodations?
In need of
Location Map?
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