this is a test page by Michael Holding | Jul 26, 2023 Prolotherapy Cadaver Workshop Registration. "*" indicates required fields Name* First Last Email* Phone*Mailing Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Specialty* Previous Prolotherapy Experience* Beginner Intermediate Advanced No How much prolotherapy do you do per week* How many years have you been doing prolotherapy?* Prolotherapy service trips*Have you attended any prolotherapy service trips? Yes No With which organisation and where?*Ultrasound experience* Beginner Intermediate Advanced No Which body parts are you most familiar with?*Additional CommentsPlease Let Us Know About Any Dietary Requests or Sensitivities:*Please ONLY register and pay for the workshops below once you have had email confirmation - this applies to nerve and general registration.Nerve Hydrodissection Workshop Registration Nerve Registration Fee ($750.00) No thanks, I only want the general registration. Prolotherapy Cadaver Workshop Registration* General Registration Fee ($2700.00) Residents Only Registration Fee ($2500.00) Total Payment MethodPayPal CheckoutCredit Card MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name Please confirm before proceeding* I am not a robot. NameThis field is for validation purposes and should be left unchanged. Δ
