Register for The Assessment and Treatment of Running and other Althletic Injuries to the Lower Quarter

Name

Address

City

Phone (cell)

Phone (other)

Email

The cost of the course is $412 which includes all materials.

Payment options:

• By check made payable to 1732166 Alberta Inc. sent to:
  Jim Meadows
  5105 403 MacKenzie Way SW,
  Airdrie, AB
  
• By VISA or MasterCard
• By e-transfer to mexicalisue@gmail.com

The fee is non-refundable except for family or medical emergencies. Registration will occur at time of payment so e-transfer is more reliable and more immediate.

For further information please email Jim Meadows at Jim@swodeam.com or call 403 829 4291

I would like to pay the full amount now with my credit card

Credit Card #

Name On Card

Expiry Date

Security #
(3 digits)

Billing Address

Electronic Signature
(please type in your full name)

Photograph emailed to Jim Meadows

(Jim says you will be forever known as “oy you” if you don’t send a picture.)

Security word for e-transfer is

(spam protection)