* next to the field is a required entry. If there is no * , the information requested is optional.
*First Name :
*Last Name :
* Email :
*Your Website URL
(http://www.your-site.com) :
*You must put a link on your website back to http://www.anatbanielmethod.com. Enter the URL of the page on your site where that link is posted :
* Language Spoken:
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*Business Name :
*Street Address :
*City :
*State/Province :
*Zip or Postal Code :
*Phone(xxx)xxx-xxxx :
Business Name :
Street Address :
City :
State/Province :
Zip or Postal Code :
Phone(xxx)xxx-xxxx :
* Geographical Area :
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Other Professional Certifications:

(for example: MD, PT, Massage Therapist, etc.)
*Your Headshot Photo :

(You need to crop and size it to fit 150px wide by 180px tall. If you do not have a graphics program, go to www.picmonkey.com and click on the EDIT button to CROP and RESIZE as needed).
Video
(please paste embed code here)
Instructions:
*My Practice:
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Enter Information about your practice and focus areas as related to ABM:
 (Max of 1000 Characters or approx. 150 words )
Enter any client testimonial(s) you want to include (optional):
 (Max of 1000 Characters or approx. 150 words)
NOTE - All submissions will be subject to review / approval and editing by the Anat Baniel Method administrator prior to publishing. Make sure your descriptive information focuses on the Anat Baniel Method and NeuroMovement.