Registration Form - Concussion Rehab Works & Vestibular Rehab Courses
Place of Employment
Phone number - enter numbers only no hyphens or brackets (for contact the day of the course)
What city/town do you work in?
Please select the course(s) you would like to attend
Vancouver, BC - Concussion Management Workshop; Level 2 - Sat, Nov 17, 2018 (WAITLIST)
Vancouver, BC - Concussion Management Workshop: Level 1 - Sun Nov 18, 2018 (WAITLIST)
Toronto, ON - Concussion Management Workshop: Level 2 - Sat Dec 1, 2018
Toronto, ON - Concussion Management Workshop: Level 1 - Sun Dec 2, 2018 (WAITLIST)
Halifax, NS - Concussion Management Workshop: Level 1 - Sat Jun 1, 2019
Halifax, NS - Concussion Management Workshop: Level 2 - Sun Jun 2, 2019
Please indicate the total you will be paying for registration. Choose one option only based on course(s) and location:
ON = $395.50
AB & BC = $367.50
NS = $402.50
Method of Payment
Do you have any dietary restrictions?
No dietary restrictions
Please indicate if we can add your email to our distribution list to learn about future courses.
A copy of your responses will be emailed to the address you provided.
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