Registration Information.
(Please enter your name as you would like it to appear on your certificate)

* REQUIRED FIELD
    
*Name:
  
Profession:
  
*Address:
  
City:
  
Province/State:
  
Country:
  
Postal/Zip Code:
  
*Phone:
  
Fax:
  
*eMail:
  

 
$500 deposit reserves your seat and special registration rate
(balance due one month before course date)

Level One: REGULAR PRICE $3,999.00 CDN Registration Special $2,899.00 CDN + applicable taxes
Registration special deadline is August 16, 2010 (First 5 registrants receive $2,299 CAD rate)
Level Two: REGULAR PRICE $1,999.00 CDN Registration Special $1,699.00 CDN + applicable taxes
Registration special deadline is August 16, 2010 (First 5 registrants receive $1,499 CAD rate)
    
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1) Please register me for Level One in Toronto, Ontario, Canada, October 2, 3, 2010: REGULAR PRICE $3,999.00 CDN. Registration Special $2,899.00 CDN + applicable taxes.
(First 5 registrants receive $2,299 CAD rate)
Registration special deadline is August 16, 2010. $500 deposit reserves my seat.

PRINTABLE REGISTRATION FORM
     
  2) Please register me for Level Two in Toronto, Ontario, Canada, October 1, 2, 3, 2010:
REGULAR PRICE $1,999.00 CDN. Registration Special $1,699.00 CDN + applicable taxes.
(First 5 registrants receive $1,299 CAD rate)
Registration special deadline is August 16, 2010. $500 deposit reserves my seat.
       (I have completed Level One) DATE OF COMPLETION:
   
  3) I wish to reserve an Accu-O-Matic microcurrent machine for purchase.
       $200 deposit required, balance due two weeks before the course.      
       Regular price $4,000.00 Course special $3,500.00 (+ applicable taxes & shipping)
      I wish to purchase an Accu-O-Matic microcurrent machine for immediate shipping.
       Regular Price $4,000 CDN, Course special $3,500 CDN (+ applicable taxes &
       shipping - Non Canadian Citizens call for shipping estimate) Save $500
   
  4) How did you hear about this event?
     Website
     Email
     Referred by PH
     Other
 
  4) PROMOTION CODE: 

       
Cancellation policy: Full refund if you need to cancel up to 30 days prior to course date, thereafter your full course fee will be applied to an upcoming event of your choice.

We reserve the right to cancel courses if required