Auricular Ear-Detox. Specialist Registration Form – INSTITUTE OF TRADITIONAL MEDICINE

Auricular Ear-Detox Specialist Registration Form

Please choose the date of your training *

Nov 2 & 3

Name *

First

Last

Email *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone *

Are you a Registered Acupuncturist or member of another Regulated Profession? If yes, please state the profession. *

Yes
No

Do you have any other previous training or certifications in the healthcare/wellness field? *

What inspires your interest in this certification? How do you plan to share the Ear-Detox/5-Point Ear Protocol?: *

Do you currently work within a Health Facility? If yes, please list the organization. *

Waiver & Refund Policy *

Waiver
Refund Policy

AGREE TO REFUND POLICY: IN CHECKING THIS BOX I AGREE THAT I AM AWARE THAT THERE ARE NO REFUNDS ON WORKSHOPS.

WAIVER: IN SUBMITTING THIS FORM AND CHECKING THE BOX ABOVE, I AGREE TO THE FOLLOWING.... I, THE PARTICIPANT RELEASE THE ORGANIZERS OF THE EVENT AND THEIR DIRECTORS, SPONSORS, EMPLOYEES AND AGENTS FROM ANY LIABILITY FOR DEATH, DISABILITY, INJURY AND PROPERTY DAMAGE. THE PARTICIPANT ACKNOWLEDGES THE RISKS INVOLVED WITH PARTICIPATING IN ANY CLASSES/PROGRAMS/WORKSHOPS AT ITM, AND ASSUMES ALL RESPONSIBILITY, AND WAIVES ANY CLAIMS THEY MAY HAVE. THE PARTICIPANT AGREES THAT THEY HAVE INFORMED THE ORGANIZERS OF ANY RELEVANT MEDICAL (HEALTH OR MENTAL) CONCERNS THAT THEY MAY HAVE. *IN SUBMITTING THIS FORM I AM ACKNOWLEDGING THAT I UNDERSTAND AND AGREE TO THE REFUND AND CANCELLATION POLICIES AND WAIVER, AT THE INSTITUTE OF TRADITIONAL MEDICINE. I ALSO AGREE TO FOLLOW ANY COVID PRECAUTIONS/POLICIES SET OUT BY THE FACILITATORS FOR THE DURATION OF THE TRAINING. I AGREE AND CONFIRM THAT I HAVE DONE DUE DILIGENCE IN CONFIRMING THE LAWS REGARDING PRACTICING THIS PROTOCOL IN MY PROVINCE OF AREA OF RESIDENCE, AND AM AWARE THAT I WILL ONLY PRACTICE THE PROTOCOL WITHIN THE SCOPE OF MY PRACTICE AND ABIDE BY ALL PROVINCIAL/LOCAL/STATE REGULATIONS.

Auricular Ear-Detox Specialist Training *

Price: $734.50

Includes HST $84.50

Total

$0.00

Credit Card Payment *

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Name on Card

Auricular Acu Training