Atlanta School of Massage: Application

Applying to Atlanta School of Massage

The online application is a two step process:

1. Fill out the Registration Form below

2. Complete the Payment Process with PayPal. There is a $100 application fee.

Massage Program Registration Form

* required field

Which class start do you prefer?*
Legal Full Name:*
Maiden Name:
Address:*
City:*
State:*
Zip:*
Home Phone:*
Alternate Phone:
E-mail Address:
Date of Birth:*

Current Occupation:*
Employer's Name:
Employer's Phone:
Emergency Contact:*
Relationship:*
Emergency Contact Phone:*

1. Have you ever been treated for any condition requiring hospitalization?*	Yes No
If yes, Please describe:

2. Have you ever been convicted of a crime?*	Yes No
If yes, Please describe:

List the names, addresses, years attended, and any degrees received from ALL educational institutions you have attended:	High School:* College: Other:

How did you hear about our school? Please be specific: