Registration Form

Name: ___________________________
Practice address: __________________
________________________________
________________________________
Postal address: ____________________
________________________________
Phone - work: (__) _________________
Phone - private: (__) ________________
Fax: (__) ___________________
Email: __________________________

Registration Fee (includes GST)


Fee for other locations will vary.
(Includes course materials, lunches, snacks, tea and coffee)
Cheque Bankcard VISA (sorry, no American Express)
__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

Expiry date / Name on card____________________

Signature (unless emailing)________________________________
Please email, fax or mail to:
Dr Margaret Taylor fax 08 8379 1254
PO Box 570, Fullarton SA 5063 Australia

For further information and nearby accommodation:
Phone 61 8 8338 3778 or email: taylorme@internode.on.net
Tax invoice will be provided at the workshop.

Workshops and Enrolment | Prolotherapy for Doctors Program | Comments from Previous Attendees | Registration