Registration Form - Vestibular Rehabilitation courses
Last Name *
First name *
Email address *
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? *
Profession *
Registration: ONLINE & IN PERSON Courses *
Required
Method of Payment *
Required
Do you have any dietary restrictions? (in person courses only)
Please indicate if we can add your email to our distribution list to learn about future courses. *
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