Listing Agreement - Massage Therapist
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Please print and mail or Fax completed form to:

Cancer Guide Service
P.O. Box 493669
Redding, CA 96049-3669
TEL: (530) 246-1374 - FAX: (530) 232-2765

Contact: Robert Nelsen


Company Name:____________________________________________________________________________

Contact Name:_____________________________________________________________________

Address:__________________________________________________________________________

City: _____________________________________________ State: _________ Zip: _____________

E-mail Address: __________________________________


Phone: ( ______ ) __________________________
FAX: ( ______ ) __________________________

MASSAGE THERAPIST ZIP CODE MARKETING LOCATOR:
$195.00 Paid Annually
(Please make payable to Cancer Guide Service.)

Listing Information:

Note: To be listed on CancerGuideService.com you must have advanced training in oncology massage therapy. 

Name:_____________________________________________________________

Address:__________________________________________________________________________

City: _____________________________________________ State: _________ Zip: _____________

Phone: ( ______ ) __________________________ FAX: ( ______ ) __________________________

E-mail: __________________________________ Web Address:_____________________________

Massage Therapist who advertise on CancerGuideService.com are authorized to use any of the following banner ads in their website or local newspapers.

Banner Ad       Banner Ad       Banner Ad

Applicants
Signature: ______________________________ Print Name: ____________________________


Date: ______________________________

Certification By
Signature: _______________________________ Date Certified: ______________________