Application to Enroll for 52nd Certification Courses   Fill out this form completely, and mail by August 31 with tuition* payable to KCIAHHMAS, P. O. Box 3940, Greenville, DE 19807.  Each Course is limited to the first six qualified applicants, with 3 enrollments minimum.  *Refunded if course is postponed. Today's Date____________  Name____________________________   Address________________________________________________________________________________   E-mail_________________________________  Home Phone (_____)______________________________   Cell Phone (_____)_______________________    Check number for tuition payment_______   ___Enclose a chronological resume of education, job and life experiences. ___Enclose an essay of any length on EACH of the following topics:  a) "Generally speaking, what interests me most at this time about the human body/mind/spirit is...."  b)  "What interests me most about my body/mind/spirit is...."  c)  "I want to study with Karen Carlson at KCIAHHMAS because...."  ___Enclose a list of the last 5 books you read.  ___Do you have any health or personal conditions for which it may be inadvisable for you to administer or receive massage?  If yes, please briefly describe.  If you are unable to answer this question, please consult your physician.  Your on-site class for every other week meets Saturdays 9:30 a.m. - 8:30 p.m. (Alternate weeks, your telephone classes are Mondays, 8-10 p.m.)  List at least three character references  1) Name _______________________________  Relationship____ Postal Address__________________________________________________________________________ Daytime Telephone (______)___________________ 2) Name _______________________________  Relationship___________________________________ Postal Address__________________________________________________________________________ Daytime Telephone (______)___________________ 3) Name _______________________________  Relationship___________________________________ Postal Address__________________________________________________________________________ Daytime Telephone (______)___________________