Wellness Institute of Digestive Health 10405 N. Scottsdale Rd suite 3 Scottsdale, AZ 85253  USA http://www.widh.org

Registration Agreement for:  Mentorship Program for Colon Hydrotherapists  Professional Closed System Colon Hydrotherapy

~ Enrollment Application ~ Name: Last:*  First:*  Middle/Maiden:*  Address: Street:*  City:*  State - Zip/Postal Code:*  AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WY Telephone: Mobile:   Office:   Residence:*  Internet: eMail:*  URL/Website:   Courses: Please Select Your Course of Interest: The Art of Colon Therapy The Mentorship Program Mentorship Program for Colon Hydrotherapist Indicate the dates you would like in order of preference. Dates Preferred: Click the numbers below for calendar.  1st:  2nd:  3rd: Length of Program: 3 days minimum, 5 hours per day. (5 days recommended) Payment Information: Tuition Amount: