DC2 Seminar CLIENT Registration Form

Please enter your Information and including TEAM Members attending.

After you SUBMIT the form, you will be directed to a payment page to pre-pay for lunch. You will receive a Receipt and Confirmation Email with seminar details.

We look forward to seeing you there!

Full Name *

Practice Name *

City *

Province *

Cell Phone *

Email *

TEAM MEMBERS ATTENDING

I / We will be staying for lunch *

YES (Payment made on next page)

NO. We will have lunch on our own.

Please contact us by text for more information:

Dr Colin Elkin: 519-732-6345

Dr. Brian Fitzgerald: 647-999-2851