IQ&IM Certified Instructor Website Listing and Contact Permission Form

$0.00

Website Listing Options
Please choose one of the following options:
I wish to confirm/update my listing as a Certified Yi Ren® Qigong Instructor on the website Instructor page and give IQ&IM permission to share my contact information with prospective students through email and phone inquiries.
I do not want to be listed on the website but give my permission for IQ&IM to share my contact information with prospective students through email and phone inquiries.
I do not want my contact information shared on the website or through phone or email.
Personal Website Listing
Your website listing will contain your name, location(s) where you teach classes, phone and/or email and/or website URL.
Name as you would like it to appear:
Email Address:
Telephone Number:
Website URL:
Location(s) you offer classes, e.g. City, State/Province, Country:
Personal Contact Information
Email Address:
Telephone Number:

Electronic Signature
Note: This item requires you to electronically sign an agreement. Please review the text and provide your name below.
IQ&IM Certified Instructor Website Listing and Contact Permission
I affirm that the information provided above is my preference regarding my Yi Ren^® Certified Instructor website listing and that IQ&IM has my permission to share or not share my contact information as designated.
Signature: *

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