Medical Massage Therapy Institute

resources for medical massage therapists

Enroll in the Massage Board Review Course

Please fill out the form completely.  By enrollling in the  course, you acknowledge that is is your responsibility
to comunicate with us and to check your email regularly for important messages and updates. 

Please send your payment to:
   Dr. Gene Desepoli
   P.O. Box 241
   Valley Stream, NY 11582

To pay with a credit card:
   Go to www.paypal.com and click on the "Send Money" tab.
   In the "To" field, enter  This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
   If you prefer that we send you an automated invoice for paying via Paypal,
      select that option in the payment method field on the form below.


Personal Details

       First Name:      required field
       Last Name:       required field

       Address:   required field
       City:           required field
       State:          required field
       Zip Code:   required field

       Phone:                   required field
       Email address:    required field


Massage School Information

       School:                               required field
       Graduation Month:         required field
       Graduation Year:             required field


 Review Course Location & Fee

       Course Location:     required field
       Fee:                             required field
       Payment method:    required field

 

 Computer

         Computer type:     required field
         Internet speed:      required field


  Referred By

         How did you hear about course:      required field
          Did anyone refer you:                       
               If yes,  by whom:                          

 

 

                                            

 
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