Alternative Pain Treatments

Occlusal Cranial Balancing Technique

Presented by Dr. Gerald H. Smith

REGISTRATION


Use this form to register for the OCB Course to be held at Shedfield, Southampton, May 19 & 20, 2006. See background and other important information at: OCB Shedfield, Southampton.

Attendance is limited to 30. No cancellations after March 31, 2006.

Provide the following background information then select "Submit". You will then be taken to our secure payment processing service (PayPal) to compelete your registration.

Note on contact information – Seminar arrangements are being coordinated from two continents. It is imperative that we are able to contact you in the shortest amount of time in the event of any changes.

Full Name:
Office Phone #:

(country code, area code, and phone number)
Home Phone #:

(country code, area code, and phone number)
Cell Phone #:

(country code, area code, and phone number)
Fax #:

(country code, area code, and fax number)
Email Address:
Confirm Email:
NOTE:Instructions on how to access Part I, the online component, will be provided to you at this e-mail address.
Your Profession:
Have you taken any
courses in cranial concepts?
Have you taken courses in osteopathic
or chiropractic concepts?
 
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|   E-Mail: info@icnr.com   |   Phone: 215-968-4781   |   Toll Free: 800-272-2323   |   Dr. Gerald Smith: ghsdoc@icnr.com   |