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Application Form To Offer A Training Course

The following application form is to be completed by holistic practitioners who would like to offer a training course through Atlantis Energy Network. All training courses are subject to our quality control measures and instructors must be prepared to demonstrate credentials as well as a statement of the results they have seen from offering their training courses in the past.

Name:
Street Address:
City:
State:	Province:
Country	Other:
Zip/Postal Code:
Phone:
Fax:
E-Mail:

Course Name:
Course Description:
Instructor Name:
Instructor Profile For Course Description:
Instructor Certification:
Prior Course Results:
Course Number Of Days:


	Yes, I would like to receive monthly updates from Atlantis Energy Network
Terms:	By submitting this application I agree to be bound by the terms of this training Agreement. I acknowledge that in no way may the training course offered make any medical claims, or promise cures. I assume full liability for delivery of the training course. In no way will the liability of Atlantis Energy Network exceed $1. I agree not to use the Atlantis Energy Network or Atlantis Natural name or logo without prior written consent. I agree that if for any reason I am unable to deliver the training course I must provide Atlantis Energy Network with written notice of same one week in advance of the planned date, and assume all costs incurred in either changing the date or canceling the course.

See our full catalog of natural health products for adults and children at www.atlantisnatural.com

Copyright© 2002-2004 DIEX, LLC. All Rights Reserved. WE MAKE NO MEDICAL CLAIMS -
INFORMATION ON THIS SITE IS NOT INTENDED TO REPLACE THE ADVICE OF YOUR DOCTOR. UNLESS OTHERWISE INDICATED, STATEMENTS HAVE NOT BEEN EVALUATED BY THE FOOD AND DRUG ADMINISTRATION. PRODUCTS ARE NOT INTENDED TO DIAGNOSE, TREAT, CURE OR PREVENT ANY DISEASE. ALWAYS CONSULT YOUR DOCTOR PRIOR TO STARTING OR MODIFYING ANY HEALTH CARE PROGRAM, IF YOU HAVE A KNOWN MEDICAL CONDITION, OR IF YOU ARE PREGNANT OR LACTATING.