The Thai Academy Registration Form
Jongrak Intatha
Mandarin Oriental Logo
Thai Buda
Personal Data
 First Name
Last Name
 
Address
 
City, State, Zip
 City
State
Zip
Contact Information
 Home Phone
Alternate Phone
Email
Course Selection:
 CEU ($400)
($100 Security Deposit)

Practioner ($1500)
($500 Security Deposit)

Day Classes or
Evening & Weekends
Security deposits can be made by check, money order, MasterCard, VISA, or AMEX