Use this form to submit therapists
Note: Only Onsen Therapists® and Onsen Students® will be added
Contents of this form are emailed to Linda Leeson for approval

Business Name:
First Name:
Last Name:
City:
Province or State:
Country
Phone Number:
Fax Number:
Address:
Postal or Zip Code:
Email Address:
Website (private):
Website (public):
Certifications: (long description) Example: Registered Massage Therapist Certified Onsen Technique Therapist
Certifications: (Just Initials) Use all upper case Separate each certification with a comma and one space Example: RMT, COTT