Registration Form for
    HT Canada Sponsored Level 4 & 5 classes

    Please print this form,
    fill it out and mail with your $100.00 non-refundable deposit
    to:   

    Healing Touch
    Canada, Inc.  RR #2, Warsaw, Ontario, K0L 3A0



    It is important to register early by sending your deposit. These
    courses are listed in the Nexus

    and on the website and no individual flyers are sent. (HT Canada
    may deem it necessary to 

    re-schedule a class if sufficient registrations have not been
    received at least 12 weeks prior.)



    Meals & Lodging: (payable
    in Canadian funds.)

    These courses are held in retreat settings & participants
    are expected to stay on-site. Usually 

    the fees are between $250 & $450 depending on the location.

    
Tuition (Including $100 non-refundable
    deposit): Level 4 (IIIA)  or Level
    5 (IIIB) 

    A $50 late registration fee is applicable to registrations
    received after the dates indicated in the 

    course schedules.

    

      
 
      

        

         Deposit $100 CDN
         
      
      

        

         Standard fee (incl
        GST):
 
        

        $425.00 CDN / $475 late
 
      
      

        

         HTI/CHNA/HTAC Member (incl GST):
 
        

        $410.00 CDN / $460 late
 
      
      

        

         Full-Time Student With ID or repeaters (incl GST):
 
        

        $215.00 CDN / $265 late
 
      
      

        

         Courses offered
        in NS are for health care professionals only. 

        A copy of diploma, certificate or degree is required with registration
        form.
         
      
      

        

         Standard fee for courses in NS, NB or NL (incl HST):
 
        

        $459.00 CDN / $509 late
 
      
      

        

         HTI/CHNA/HTAC Member courses in NS, NB or NL
        (incl HST):
 
        

        $443.00 CDN / $493 late
 
      
      

        

        Full-Time Student with
        ID or Repeater in NS, NB
        or NL incl HST:
 
        

        $232.00 CDN / $282 late
 
      
    

    

      

        

        Class Level ______ Location__________________________________
 
        

        Dates__________________
 
      
      

        

        Name_____________________________________________________

        (as you would like it to
        appear on your certificate of attendance)
 
        

        female  or male 
 
      
      

        

        Address___________________________________________________
 
        

         
 
      
      

        

        City__________________________________
        Prov________________
 
        

        Postal Code___________
 
      
      

        

        Home phone___________________________
        Work_______________
 
        

        I am a nurse yes 

        no
 
      
      

        

        Email_____________________________________________________
 
      
      

        

         L4 registrants include copy of Level 3 certificate
        of attendance (IIB)
 
        

        Credentials: ___________
 
      
      

        

         L5 registrants include copy of Level 4 certificate
        of attendance (IIIA)
 
        

         
 
      
      

        

        I am a full-time student with student
        ID no
        yes
 
        

         
 
      
      

        

        Repeater  no  yes - date of previous Level
        4 or 5____________
 
        

         
 
      
    

    
I authorize my name, address,
    telephone number & email as shown above to be included on
    the class participant list & to be shared only with class
    participants, HT International & the Healing Touch Association
    of Canada for networking purposes.

    
Signature: ___________________________________________
    Date: _____________________