The Comprehensive Straight Wire & Functional Orthodontic Program: Course Registration

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Registration/tuition information for CSW courses in Canada.

First name:	Last name:
Address:
City:	Province:
Postal Code:	Fax:	Email:
Home Phone:	Cell Phone:	Office Phone:

Please Choose One:

$1,250.00 + HST upon application/registration, with $1,250.00 + HST due at each session 1-4.
A 5% discounted cost of $5,937.50 + HST available if full payment accompanies application/registration.

Total: $

Choose your starting session

Pick a date and location:

Method of Payment

Visa --> Mastercard

Card # Expiry:

(to mail or fax registration)

Telephone Registration: Call Comprehensive Straight Wire at 1-877-20-ORTHO

Fax completed application and $1,250.00 + HST for 1^st session or discounted total of $5,937.50 + HST to 1-877-20-ORTHO
OR mail to:

Comprehensive Straight Wire
P.O. Box 2063
Caledonia, ON
N3W 2G6

Upon receipt of application and fees, SESSION 1 material will be forwarded.
Please reply as quickly as possible. Registration limited.

References on request at 1-877-20-ORTHO