Course
Registration

Please select the courses that you want and then fill in your personal information.
Items with Red Stars must be filled out.

* Course 1:
Course 2:
List Dates for Your Course
* First name:
* Last name:
Initials:
* Street Address:
* City:
* Province/State:
* Country:
* Postal/Zip code:
* Home Phone:
Please add area code, i.e. 123-123-1234
Post Secondary Education:
* I have read the policies:
Date of Birth:
DD/MMM/YYYY such as 01/jan/2000.
Business Phone:
E-mail address:
How do you want us to contact you? Email Home phone Business phone Mail

Please visit our website, http://www.collegeofacupuncture.com, for information of payment options, policy and procedures and any other course requirements.

Please ensure the following is included with your application:

Signature ________________________________________

Note: The school reserves the right to cancel the course's program if there is insufficient enrolment. Should the program be cancelled, the applicant will receive a complete refund.

Thank you and please don't forget to send your deposit to confirm your space in the course.


Fields highlighted with red stars must be filled in!
Underlined fields must be filled in

Mail to:
College of Acupuncture and Therapeutics Inc.
144 Ann Street
Kitchener, ON N2B 1Y3
(519)885-6401 or 1-866-615-2787