If you would like to register for the ETPS^SM Neuropathic Therapy Course, introductory level, you can either fill out the form below and a customer service representative will contact you, or you can download the attached form and fax it to our office at 416-253-1911.

The fee per person is $249.00.00USD for this course if registered 2 weeks in advance. Course fee is $279.00USD after early registration deadline. Price includes workshop instruction and a comprehensive workbook.

** Required Fields

Seminar City	**
Seminar Date:	**
Names of Attendees and their certifications **
1. PT | OT | RMT | RN | DC| License #:
2. PT | OT | RMT | RN | DC| License #:
3. PT | OT | RMT | RN | DC| License #:
Company Information
Organization
Address
City:
Province/State
Postal/Zip
Phone	**
Fax
Method of Payment	**
Cheque (to be made payable to Acumed Medical)
Credit Card
Bill my organziation to the Attn:
In order to process the above information and to issue a receipt, we require the following information as well: Contact Person: ** Email Address: **
Please note if you are paying by credit card, we will contact you shortly. Also full registration fee is due and payable prior to start of workshop