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Course Enrollment

Personal Detail

Title:

First Name*:

Last Name*:

Address Line 1:

Address Line 2:

City:

Postcode:

Country:

Cellphone:

Phone :

Email*:

Clinician Details

Occupation:

HPCSA/AHPCSA no (REQUIRED):

Qualifications:

Clinic Name:

Clinic Owner:

Address Line 1:

Address Line 2:

City:

Postcode:

Phone:

You are booking the following course:

Please select up to six courses you wish to register for at this time. Once we receive your registrations, we will email you to advise the final cost and payment options.

Please check this is correct before applying:

Additional Questions

Do you have any food allergies?

R3500.00
(Early bird fee - R3000.00 if full payment is received before 25 October 2024)