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DEPARTMENT OF POSTGRADUATE AND CONTINUING EDUCATION

Seminar registration

PRINT THIS FORM TO MAIL OR FAX

Every attempt is made to offer this program as announced. However, Life Chiropractic College West reserves the right to adjust program faculty, locations, dates, times and tuition to accommodate unanticipated occurrences, and to cancel due to insufficient enrollment. Life West will only notify advance registrants of any cancellation or program changes. Life West is not responsible for any expenses incurred by registrants due to adjustments or cancellations.

A $50 processing fee will be charged for refunds if the registrant provides written notice of cancellation at least one (1) business day prior to the seminar start date. Registration is nonrefundable if the program for which it applies is conducted as scheduled; however, a credit voucher may be issued, minus a $25 processing charge. A credit voucher must be requested within sixty (60) days of the seminar end date. The credit voucher may be applied towards another Life West program and must be redeemed within one (1) year of the original scheduled program date or it will be forfeited.

Complete a separate registration form for each person attending

Please register me for the following course(s):

Clinical Anatomy Lab

X-Ray: Interpreting Spinal Trauma Images Down to the Bone - Assessing Bone Density X-Ray: Clinical Justification for Imaging

Low Tech Spinal Rehabilitation Lower Extremity Adjusting Stress Management for Mental Subluxations

Validating Chiropractic

Date of course:

Course location:

Name:

License number(s)

Address:

Phone

City/State/Zip:

Fax

e-mail address:

LCCW Alumni Grad year

Payment by:

1Check 1 Money order
(US funds, payable to Life Chiropractic College West)

Registration is not complete until registration fees have been paid

Credit card #

Expires:

Security code

Registrations with a credit card payment may be faxed to:

510.780.4518

Or mail this completed form with your payment to:

Department of Continuing Education

Life Chiropractic College West

25001 Industrial Blvd

Hayward, CA 94545

Clinical Anatomy Lab
X-Ray: Interpreting Spinal Trauma Images	Down to the Bone - Assessing Bone Density	X-Ray: Clinical Justification for Imaging
Low Tech Spinal Rehabilitation	Lower Extremity Adjusting	Stress Management for Mental Subluxations
Validating Chiropractic

Date of course:		Course location:
Name:		License number(s)
Address:		Phone
City/State/Zip:		Fax
e-mail address:		LCCW Alumni Grad year
Payment by:	1Check 1 Money order (US funds, payable to Life Chiropractic College West)	Registration is not complete until registration fees have been paid
Credit card #		Expires:
		Security code