Medical Massage Registration Medical Massage June 2020 Step 1 of 3 - Basic Information 33% Course registration is open. Medical Massage Hands-On Workshop takes place from June 6-7, 2020 for 2 days, 4007 Automation Way, Fort Collins, Colorado USA Cost for the program: $2,250 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)*Upload a copy of your current veterinary license or letter from your school showing that you are a student in good standing or a faculty member that does not require a veterinary license to teach and practice. You will be enrolled in the course once this has been received, reviewed, and accepted.Accepted file types: pdf, jpg, png, .Formats accepted are pdf, jpg, png. The file will upload when you submit the form. Contact InformationMailing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Is this address your home or work address?* Home Work Work PhoneCell Phone*Email Address (preferred for course material)* Program SelectionCheck the selection below that applies to you*VeterinarianVeterinary Rehabilitation Specialist4th Year Veterinary StudentAll student applicants must be members of SAVMA and provide proof of professional liability insurance. Please upload below.Accepted file types: pdf, jpg, png.Formats accepted are pdf, jpg, png. The file will upload when you submit the form. 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 VET 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 VET. 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 ItemsSign Up for Our Course Announcements Sign me up! PaymentsCourse Fee - $2,250 USDMedical MassageCoupon Total Due $0.00 Will you be paying by credit card or check?*Credit CardCheck (mail to CURACORE VET, 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 VET" and mail to: CURACORE VET 905 S Summit View Dr Fort Collins, CO 80524 For your security, please send payment with tracking information. Questions? Contact us at email@example.com or 970-818-0851.CommentsThis field is for validation purposes and should be left unchanged.