Medical Massage Registration Medical Massage and Myofascial Palpation June 2019 Step 1 of 3 - Basic Information 33% Course registration is open. Hands-On Workshop takes place from June 8-9, 2019 for 2 days, in Fort Collins, Colorado USA Cost for the program: $1,250 USD Registrations are accepted from qualified applicants on a first-come basis until we reach maximum enrollment. After you register we will enroll you into the Litmos learning system to access the assessments that go with the book Canine Medical Massage - Techniques and Clinical Applications by Narda G. Robinson, DO, DVM, MS, FAAMA and Shelly Sheets, BA, CMT, CAMT to be purchased separately. See the webpage for a link to AAHA Press. Basic InformationName* First Last Preferred Name on BadgeTitle DVM MRCVS VMD Name for Certificate of Completion (including degrees)*Practice Focus (check all that apply) Large Animal Small Animal Equine Exotic Other If 'Other,' please specify your practice focusVeterinary College and Year of Graduation*State Where Licensed or Certified*License or Certificate Number (upload a copy of your license below)*Please upload a copy of your license here.Accepted file types: pdf, jpg, png, .Formats accepted are pdf, jpg, png. The file will upload when you submit the form. 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Home Work Work PhoneCell Phone*Email Address (preferred for course material)* Program SelectionCheck the selection below that applies to you*VeterinarianFourth-Year Veterinary Student §Veterinary Rehabilitation Specialist§ Fourth-year students must provide a letter verifying that they are a student in good standing from the veterinary school's Dean's Office. Terms and Conditions Returned Check Policy There will be a $35 fee for checks returned for insufficient funds and course will be suspended until payment clears. Cancellation Policy CuraCore reserves the right to cancel the course or any clinical intensive(s), and to change the dates or venue of the intensive(s). A full refund will be given if the course is cancelled. No refunds will be granted once you have started the course. I understand that by submitting this registration form and the course registration fee to reserve a seat in the upcoming Medical Massage course that the course registration fee is non-refundable per policy. I have read, understood, and agree to the terms and conditions contained herein. I further understand that by signing below, I have reviewed and agree to the course curriculum, subject to such changes as may be approved by CuraCore. Type your name in here to indicate that you agree to the terms outlined above*End User Agreement* I agree. Note: By clicking "I Agree" you acknowledge that you have read and agree to the terms set forth in the end user agreement. You must read the linked document and check the box above to continue with the form.Additional ItemsDietary RequestsVegetarianVeganGluten Free/SensitiveOtherIf 'Other,' please describe dietary requestSign Up for Our Course Announcements Sign me up! PaymentsCourse Fee - $1,250 USDMedical Massage and Myofascial PalpationCoupon Total Due $0.00 Will you be paying by credit card or check?*Credit CardCheck (mail to CuraCore, 905 S Summit View, Fort Collins CO 80524) Note: If paying by credit card, you will be asked to enter your billing address separately when checking out. If paying by check, please make payment to "CuraCore" and mail to: CuraCore 905 S Summit View Dr Fort Collins, CO 80524 For your security, please send payment with tracking information. Questions? Contact Sharon Sherwood at firstname.lastname@example.org or 970-818-0851.CommentsThis field is for validation purposes and should be left unchanged.