Registration

Registration Form

Please make payment to;
Vivian Dim
Occupational Therapy Professional Corporation
4413 Ontario St., Suite 202
Beamsville, ON.
L0R 1B3
Fax Registration; 905-563-6731

COURSE COST – Deadline – March 28th Early Bird - One day = $245, for two days = $490, For all three days = $735. EARLY BIRD DEADLINE is MARCH 28th, 2014 (after the early bird course cost increase by $50 per course – proof of prerequisite completion necessary)

CANCELLATION AND REFUND Registration fee less $50 will be refunded if written cancellation is received 27days prior to the course. Beamsville physiotherapy and Arm More Therapy reserve the right to cancel at any time with full refund.

Name
FirstLast
Address
Street AddressAddress Line 2CityState / Province / RegionZIP / Postal CodeCountry
Email
Phone
Please Check The Course You're Signing Up For...*
- KT3 Clinical Concepts and Advanced Whole Body
- KT4 Specialty Neurological Concepts
- KT4 Specialty Lymphatic Concepts
I will send proof of prerequisite for the registered courses.*
- KT3 course documentation required is Attendance Verification Form and Certificate of Completion
- KT4 course KT3 Attendance Verification Form and Certificate of Completion is required
Do you have any food any food sensitivities/allergies?
Please list any foods that you are sensitive or allergic to.
Professional Designation
Facility
Payment*
- I will mail a cheque within 3 days.
- I will call in credit card information.
- I will fax credit card information.
Please make payment to; Vivian Dim Occupational Therapy Professional Corporation 4413 Ontario St., Suite 202 Beamsville, ON. L0R 1B3 Fax Registration; 905-563-6731