registration New Mexico
First Name
Last Name
Street Address
City
State
Zip
Phone
Email
Educational Degree
Licensure
Do you have any past or
pending actions against
your license?
If yes, please explain
(confidential)
Payment Method
Please wait for confirmation that you have been accepted prior to sending payment.
To pay by check, make check payable to:
Sharon Stanley, Ph.D and send to:
Somatic Transformation
6172 Old Mill Rd Ne
Bainbridge Island, WA 98110-3141, US
If you wish to pay by credit card, we will contact you to obtain card information once your registration has been accepted.
