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Certified Infant Massage Instructor Sign Up

Thank you for your interest in joining FNWL's Certified Infant Massage Instructor Program. Once approved into the program, you will be given your own unique 10% off discount code that you may use towards all of your qualifying purchases totaling $125.00 or higher. Complete details will be provided to you once your application is approved.

To apply, please complete the following brief application form. Your responses will be kept confidential and your information will not be sold.

To be eligible for this offer, we must be able to verify that you hold a current certification as a CIMI. Once you have submitted the below application form, we will supply details on how to fax or mail a copy of your CIMI Certificate for verification. We apologize for any inconvenience presented, but we are not able to approve CIMIs that cannot be verified.

Contact Information
Your First Name:
Your Last Name:
Address:
City:
State:
Zip Code:
Country:
Phone:
E-mail:
Web Site URL:
Additional Information
Average # of Students Per Year:
Average # of Courses Per Year:
How Long Have You Been Teaching?
Where Do You Teach?
Please Name the Courses That You Teach:
On Average, How Many Students Do You Teach Per Course:
Please list your qualifications (educational background /experience):
Please list the ingredients that you use most:
Are you looking for an ingredient supplier to recommend to your students?	Yes No
Comments or Additional Information:
By submitting this form, you give us permission to contact you occasionally by telephone and/or e-mail. We will keep your information confidential.


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Natural Sourcing, LLC
341 Christian Street Oxford, CT 06478

Phone: (800) 520-2060 or (203) 267-6061
Fax: (203) 267-6065
E-Mail Addresses