Event Location *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Contact Person *

First Name

Last Name

Contact Phone *

Contact Number

(###)

###

####

Length of Chair Massage Session *

This is the length of each individual chair massage.

10 minute

15 minute

20 minute

Other

Event Duration *

How long will you like chair massage services for? (2-hour minimum required)

Two Hours

Three Hours

Other

Event Date *

MM

DD

YYYY

Event Start time *

Hour

Minute

Second

AM PM

Event End Time *

Hour

Minute

Second

AM PM

Frequency *

One time

Weekly

Monthly

Other

Payment Option *

Please refer to the chair massage information booklet you received.

Option A: Company-Sponsored

Option B: Cost-Share

Option C: Members

Not sure