ATTENTION - VIP Members! To receive the VIP Membership discount, you MUST log in before completing this form.
Practice or School Affiliation
Your Mailing Address(*)
Please enter your address
Have you successfully completed the Basic I seminar?(*)
** NO REFUNDS WILL BE GIVEN IF DOCTOR CANCELS INSIDE OF TWO WEEKS. HOWEVER, THE PAYMENT CAN BE USED FOR ANY OTHER WORKSHOP OR SEMINAR WITHIN A TWO YEAR PERIOD.