Name

Phone

Email

How did you hear about the course?
(If you were referred by someone, please indicate by whom as well as their email address if you have it – so that we can thank them.)

Briefly describe your professional background
(What is your prior education/experience with musculo-skeletal anatomy? How long you’ve been practicing your profession? Where did you do your training?)

What do you hope to get from this course?

WITHDRAWAL POLICY

If you decide to withdraw from the program, and you do so prior to the start date of the course, you will be given a full refund minus a $100 processing fee. However, please note that once the course begins there will be no refunds given, for any reason. If unforeseen circumstances arise that prevent your continued attendance in the course after it has begun, you can transfer your enrollment to a friend or colleague, who would pay you directly.

Please Type and initial your name below to indicate your understanding of these terms.