Courses and Events Registration

Name:
Address:
City:
State:
Zip Code:
Phone:
Email:
Course I am interested in taking:
Date Of Registration:
Total Payment Included:
Credit Card:
   CC#
Expiration Date (XX/XX):

If paying by check or money order, print out form and send with payment to:

Hawaii Wellness Institute
3670 Kalihi Street
Honolulu, HI 96819