Print This Page FILE>PRINT BACK TO patdeacon.com
APT WORKSHOP REGISTRATION FORM

NAME:                                                                        PHONE:

POSTAL ADDRESS:

EMAIL ADDRESS:                                                          WEBSITE ADDRESS:

HOMEOPATHIC STATUS:
oStudent? Commencement year?                    oPractitioner? Number of years in practice?

WHAT ATTRACTED YOU TO THIS COURSE?
WHAT DO YOU HOPE TO GAIN?

SELECT PAYMENT CHOICE:
o$225 + GST ($238.50) includes snacks.
o$195 + GST ($206.70) if paid at least one month prior.

SELECT PAYMENT METHOD: oCheque or Money Order  oMasterCard
nAccount #:                                                nExpiry Date:

YOUR SIGNATURE AND DATE: 

We expect participants to attend the entire course. Accommodation and travel costs are not included. Contact: Pat Deacon 250-492-0336 or Jude Dawson 250 804 0104

Mail this completed form together with your payment made payable to:
Pat Deacon 734 Creekside Rd Penticton BC V2A 2C4

Print This Page FILE>PRINT BACK TO patdeacon.com