for quick sign-up call 001-905-450-7870 or complete and ... · meridian health education, c/o queen...
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REGISTRATION FORM
Meridian Health Education, C/O Queen West Physiotherapy & Acupuncture, 345 Queen Street West, Units 1, 3 and 4 Brampton, Ontario L6Y 3A9 t: 905.450.7870 f: 905.450.0920 e: [email protected]
ACUPUNCTURE & DRY NEEDLING FOR THE FOOT AND ANKLE May 21 to May 24, 2018, 9am to 1pm Course Location for all 3 days: Pomegranate Wellness Spa Hotel, Halkidiki GREECE Tom offers ongoing mentorship just a phone call away or by email at any time in order that your reinforce your newly acquired knowledge and gain 100% confidence in immediately using your acupuncture skills for optimal effectiveness. We also offer additional courses (Intro, Upper Extremity, Cervico-thoracic, Lower Extremity, Lumbopelvic, Balance Technique and Headaches). Future dates to be determined. After completing courses, please complete proper form provided by CPTNB and submit to them asap before performing acupuncture and dry needling in your practice. *NOTE: a minimum of 25 registrants required for each course (we will notify you one week prior to course dates if the required number has not been reached, and you will receive a refund if courses have been cancelled).
For Quick Sign-Up call 001-905-450-7870 or complete and fax/mail the form below:
* Please check your option below. YES! Sign me up and I’ll pay for this course before Nov 10, 2017 for the Super Early Bird price of $800 CDN. YES! Sign me up and I’ll pay for this course before Dec 31, 2017 for the Early Bird price of $900 CDN. YES! Sign me up and I’ll pay for this course after Dec 31, 2017 for the regular price of $1100 CDN. *PLEASE PRINT IN LARGE CAPITAL LETTERS Cheque enclosed (make payable to Meridian Health Education ) Please charge to my: Visa MasterCard Card Number: _______________________________________________ Expiry: ______________ Name: ______________________________________________________ Street Address: ______________________________________________ City/Province: ______________________ Postal Code: _____________ Phone: (_________) __________________________________________ (In case we have questions about your information) Email Address: ______________________________________________ (For course confirmation, to receive online updates/newsletters. Your email will be kept confidential) Signature: ______________________________________ Fax to: 905-450-0920 Mail to: Queen West Physiotherapy and Acupuncture 345 Queen Street West Unit 1, 3, 4 Brampton ON L6Y 3A9, CANADA
Refund Policy: No refunds for cancellations after February 20, 2018. Refund minus a $50 CDN administrative fee is provided if notice is given prior to February 20, 2018.