COURSE REGISTRATION UQ Edmonton November 7-9

Name *

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

I have read and understand my college guidelines and the rules/regulations for me to practice Dry Needling within those guidelines

I am currently registered and in good standing with my college (please provide copy of license)

If travelling from out of province I have applied for courtesy registration

I understand that this course requires active participation including being needled throughout the weekend

Course Payment Options

Combined with LQ course - total cost $2700

UQ course only $1500