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TO REGISTER:
Print off registration
form below and send along with posted-dated cheque to:
Sports
First Responder
164 Westcroft Road
Beaconsfield, Quebec
CANADA H9W 2M3
Cheque
payable: Osteo-MedSport
*Cheque dated 1st day of course
CERTIFICATION:
** $500.00 (given locally/sponsored) ***$550 (given out-of-region)
(includes $80 Red Cross text and $20 SFR manual)
RE-CERTIFICATION ** $340.00 (given
locally/sponsored) ***$350 (given out-of-region)
(includes $20 SFR manual, Red Cross text is optional and is
available for an additional $80 if pre-ordered.)
* Post-dated cheques
should be dated for first day of course.
** Registration fees as of January 01st, 2010.
***Out of region courses are subject to additional fees
if not sponsored- see notation beside course.
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SFR REGISTRATION FORM
FIRST NAME: ___________________________
FAMILY NAME :___________________________
DESIGNATION: CAT(C) ____ CATA(cand)____ ATC______
PT/pht
___ SPC_____ MD___ Other:____
ADDRESS: ______________________________
CITY:____________________
PROVINCE: _________ POSTAL: _____________ PHONE:( )______________
E-MAIL: ________________________________(mandatory- needed for confirmation)
DATE:______________________
LOCATION:__________________
LANGUAGE:__________________
Certification: ________________
Re-Certification:______________ ( include photocopy of
current card)
Course Fee: _________________
updated: Jan
29th, 2010
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