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Lecoq
 Practice Development

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You may use this form to register for any of our courses or programs. 
Or you can ask us to contact you for information about any of our offerings.  

To protect your security, we do not collect financial information over the web.
We will call you to handle credit card or other payment arrangements. 

Your Full Name:      Title:

Course/Date           (Includes courses in development)

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Address:  (If international, type your complete address in this box)

                          

City:                         State:      ZIP:

Office Phone:         Email: 

                           Who plans to attend?   Please list all names and titles:
      Doctor(s):    

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                           Contact Information - For information, payment arrangements:

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Lecoq Practice Development
14420 Iroquois Rd. Apple Valley, CA 92307

CONTACT US BY PHONE:     877-203-9100
To Reach Thomas Lecoq:  idealvt@verizon.net
To Reach Amee Lecoq: idealvt1@verizon.net 
For Therapist Training, Lyna Dyson:  visionhlp@juno.com
For support calls or to fax 760-240-4794
 

Copyright © 2009 Lecoq Practice Development
Last modified: 06/21/10