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:
Winnipeg, MB - Concussion Management Workshop - Sat, April 14, 2018
Montreal, QC - Concussion Management Workshop - Sat, May 12, 2018
Ottawa, ON - Concussion Management Workshop - Sun May 13, 2018 (WAITLIST)
Edmonton, AB - Concussion Management Workshop - Sat Oct 13, 2018
Calgary, AB - Concussion Management Workshop - Sun Oct 14, 2018
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
AB, MB & QC - Concussion Management Workshop = $367.50
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.
Please complete the captcha before submitting the form.
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