Page 270 - Massage Therapy School Program

Massage Therapy School Program Order Form
To complete this form online visit: www.performancehealth.pro/SchoolForm ____ New Participant – Signup ____ Current Participant – Reorder
General Information - The following information is required to process all orders. Please print. School name: ______________________________________________________________________ School website: _____________________________________________________________________ Contact name and title________________________________________________________________ Contact phone number: ____________________________ Email: ____________________________ Ship to address (no P.O. Box): _________________________________________________________ City: ________________________________________ ST: ______ Zip:_______ (US shipments only)
The following information is required for NEW program participants. Please print.
Number of school locations: _________________ Total number of students: _________________
Do you use Biofreeze® pain relieving products in your school? Do you sell Biofreeze® pain relieving products at your school? Do you currently use Prossage® Heat in your school?
Materials Requested
• MT Educational Resource Book – Limit one per campus.
___ Yes ___ Yes ___ Yes
___ No ___ No ___ No
Quantity _____
_____
_____ _____
_____ _____
_____ _____
• Student Sample Kits – all include Biofreeze and Prossage product samples.
- MT Hands-on Classroom Kit – Used with the Topical Analgesics 101, Cervical
Contrast Treatment, and Forearm, Wrist and Hand Treatment Teaching Modules, or with any other classroom topical subject.
- MT Retailing Kit – Used with the Massage Therapy & Retailing Teaching Module. Also Includes merchandising and marketing tools to build your practice.
- Self-Care Kit – Used with the Self-Care Strategies Teaching Module. Also includes 5’ pre-cut Red Thera-Band Professional Elastic Resistance Band.
• MT Treatment Manual
• Student Graduate Kit – Provide Biofreeze® and Prossage® product samples as a gift.
Date of next graduation _____________
• Customized Samples - 3 gm Biofreeze packet attached to brochure
Clinic Samples – limited quantity of 200 Event Samples
Date needed ___________
___________
___________
___________
___________
___________
___________
___________
Please note comments/questions here _____________________________________________________
Return completed form via e-mail education@performancehealth.com or Fax 330-633-0205, Attn: Education Coordinator
PLEASE ALLOW FOUR TO SIX WEEKS FOR DELIVERY OF ALL PRODUCTS AND SAMPLES
P04620, Rev 4