Payment Options: Checks: Please make checks payable to: Restorative Health Services 1272 Garrison Drive, Suite 307 Murfreesboro, TN 37129 Attention: Lauren Vaughn Phone-615-890-2160 Fax-615-890-2361 Online: www.rhs-tn.com Credit Card: To send credit card payment in by fax: Fax-615-890-2361 Complete cardholder information and fax to: or e-mail: lvaughn@rhs-tn.com Cardholder Information: Name: Type: AMEX, MC or VISA Cardholder’s (as it appears on credit card) (circle one) Address: Credit Card #: Expiration Date: City, State, Zip: Security Code: Signature: (3 digit # on back of card for Visa and MC; for AMEX, 4 digit # on front of card above the credit card #.) Restorative Health Services is authorized to charge my credit card as Instructed. Registration is not confirmed until payment received.
Payment Options: Checks: Please make checks payable to: Restorative Health Services 1272 Garrison Drive, Suite 307 Murfreesboro, TN 37129 Attention: Lauren Vaughn Phone-615-890-2160 Fax-615-890-2361 Online: www.rhs-tn.com Credit Card: To send credit card payment in by fax: Complete cardholder information and fax to: Fax-615-890-2361 or e-mail: lvaughn@rhs-tn.com Cardholder Information: Cardholder’s Name: Type: AMEX, MC or VISA (as it appears on credit card) (circle one) Address: Credit Card #: City, State, Zip: Expiration Date: Signature: Security Code: (3 digit # on back of card for Visa and MC; for AMEX, 4 digit # on front of card above the credit card #.) Restorative Health Services is authorized to charge my credit card as Instructed. Registration is not confirmed until payment received.
FinalAttendeeRegistrationGaitseminar.docx