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Course Registration Form
Treatment and Management of the Hemiplegic Shoulder and Upper Limb
From Oct 22 to 24 2010
- Timmins and District Hospital
   
Name:_________________________________
 
Occupational Therapist
Telephone (home):________________________
 
Physiotherapist
Email:__________________________________  
Street:_________________________________  
Suite:__________________________________  
City  :__________________________________  
Province/state:____________________________ Work Place:_______________________
Postal/Zip code:___________________________ Date of Birth:_______________________
 CPA-NSD Member
 
 $ 474.00
CPA Membership No.:_______________
 CPA/CAOT Member
 
 $ 508.00
CAOT Membership No.:______________
 Non- member
 
 $ 604.00
College Registration No.:_____________

Course fees must be paid by cheque or money order payable to “CBIA, Canadian Bobath Instructors Association”. Please print this page, and mail this completed form with your cheque to:

Canadian Bobath Instructors Association,
c/o P.O. Box 19656,
Vancouver, British Columbia,
CANADA, V5T 4E7

If sent via courier, please do not request signature at delivery point. If you have any questions, please contact us.

Applications are received on a first come first served basis and course places will be reserved when accompanied with a current dated cheque. Course application fees will be deposited on receipt of your application in order to reserve your course place. (Basic Course requires a $700 deposit and the balance due one month before course starts)

Cancellation policy: For cancellation prior to the deadline, a $50.00 processing fee will be charged. For cancellation after the deadline no refund will be provided, unless the space can be filled from the wait-list, at which time a $100.00 processing fee will be charged. In the event that CBIA cancels the course for any reason, full refunds will be provided.
 
Signature:___________________________________
Date:_______________________________________  
 
 
P.O. Box 19656, Vancouver, BC, Canada, V5T 4E7   Fax: 604 321 5827 Email: admin@cbiaorg.com