Blatman Method Course - REGISTRATION Please fill out this form to register. If you have any questions, contact the office. Thank you! Name* First Last Professional Designation*Company/OrganizationAddress* Street Address City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzechiaDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTürkiyeTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Email* Cell Phone*How did you learn about The Blatman Method Certification?*Choose OneInternet SearchSocial MediaSpeaking EngagementPrint PublicatonOtherMore Detail About How You Found Us:*Please provide more detail regarding how you heard about The Blatman Method. Thank you.Class OptionsChoose Class Option* Physician (MD, DO) Naturopathic Physician (NP) Dentist (DDS) Nurse Practitioner (RNP), Nurse (RN), PA Pharmacist (RPh), Chiropractor (DC) (non-injection) LMT, OT, PT, Allied health care (non-injection) Payment Details and OptionsSelect Your Payment Option (MD, DO) Pre-pay discount PLUS 15% OFF for a limited time ($15,000 - 15% = $12,750) Session 1 Only ($3,195) Select Your Payment Option (NP) Pre-pay discount PLUS 15% OFF for a limited time ($15,000 - 15% = $12,750) Session 1 Only ($3,195) Select Your Payment Option (DDS) Pre-pay discount PLUS 15% OFF for a limited time ($15,000 - 15% = $12,750) Session 1 Only ($3,195) Select Your Payment Option (RNP, RN, PA) Pre-pay discount PLUS 15% OFF for a limited time ($15,000 - 15% = $12,750) Session 1 Only ($3,195) Select Your Payment Option (RPh, DC) Pre-pay discount PLUS 15% OFF for a limited time ($7,975 - 15% = $6,778.75) Session 1 Only ($1,595) Non-injectionSelect Your Payment Option (LMT, OT, PT, Allied health care) Pre-pay discount PLUS 15% OFF for a limited time ($3,900 - 15% = $3,315) Session 1 Only ($950) Non-injectionTotal $0.00 Terms* I agree Read TermsForm Submission TermsCloseBy providing your phone number and submitting this form, you agree to our Terms & Conditions and consent to receive SMS messages from Blatman Health and Wellness for updates, scheduling, and promotional purposes. Message frequency varies. Message and data rates may apply. Text STOP to opt-out or HELP for help. Read our Privacy Policy and Terms & Conditions.SecurityCredit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20262027202820292030203120322033203420352036203720382039204020412042204320442045 Expiration Date Security Code Cardholder Name
