Participant Info

First Name
Terie
Last Name
Tishim
Address
City
State
Country
Zip Code
Phone

Personal Info

Company Logo Image
Photo
Website, or Blog
password

Business

Bio
I agree to ISTA's Code of Ethics
yes
Certifications
Services Offered
Proof of Liabilty Insurance
Liability Expiration Date
August 12, 2020
Types of Sessions
Instruments / Modalities