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 choose which course(s) you would like to register for:
Vancouver, BC - Concussion Management Workshop - Sat, Nov 11, 2017 (WAITLIST)
Kamloops, BC - Concussion Management Workshop - Sun, Nov 12, 2017 (WAITLIST)
London, ON - Concussion Management Workshop - Sun, Dec 3, 2017
St. Thomas, ON - Intro to Vestibular Rehab - Fri/Sat, Dec 1-2, 2017 (WAITLIST)
St. Thomas, ON - Advanced Vestibular Rehab - Sun, Dec 3, 2017
Please indicate the total you will be paying for registration. Choose one option only based on course(s) and location:
ON - Concussion Management Workshop = $395.50
BC - Concussion Management Workshop = $367.50
ON - Intro to Vestibular Rehab = $593.25
ON - Advanced Vestib Rehab = $355.95
ON - Intro & Advanced Vestib Rehab = $892.70
ON - Intro to Vestib Rehab & Concussion = $932.25
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.
Please complete the captcha before submitting the form.
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