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International Academy of Chiropractic Acup.
291 Main Road
Holden, ME 04429
207-989-0000 Fax: 207-989-0752
www.iaca.cc
Registration Form
Name:_____________________________________________
Address:____________________________________________
Zip Code:___________________________________________
Phone:_____________________________________________
Credit Card Number:__________________________________
Expiration Date:______________________________________
Amount:____________________________________________
CID: (Last 3 Digits on Back of Card)______________________
Signature:___________________________________________
Seminar Fees:
Member:____________________Non
Member:____________
545.00 (3 Weeks Prior)
595.00 (3 Weeks Prior)____
565.00 (2 Weeks Prior)
615.00 (2 Weeks Prior)____
585.00 (1 Week Prior)
635.00 (1 Week Prior)_____
Registrations are accepted up to 90 days prior to the seminar date.
Refunds
will be issued for full refund amount within two weeks of seminar date. Fifty percent will be issued within less than two
weeks. No refunds will be issued less than seven days notice.
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