SIRIUS - Wilderness Medicine

Enrollment in all courses is limited. To reserve a space, please send in this registration form along with the course fees and applicable sale tax (GST, PST). Upon receipt of registration and course fees a letter of confirmation will be sent to you along with course details, map and information related to your course. If for any reason SIRIUS WILDERNESS MEDICINE is obliged to cancel a course, you will be entitled to full refund.

Our registration form can also be downloaded and faxed / mailed to us at:

SIRIUS WILDERNESS MEDICINE
1158 rue Duquette
Val-David QC, Canada J0T 2N0
Tel: (819) 322-5815
Fax: (819) 322-2019

ASCII Registration Form (1.3k)
MS Word 6.0 Registration Form (10k)

On-line Registration Form

Personal Information
Name:
Street:
City:
Prov/State:	Postal Code:
Country:
Tel# Home:	Tel# Work:
Fax #:
Email:

Course Selection

Enter the course ID number of the course which interest you. Please note that contained in each ID number is the language of instruction, the course date, and location. Make your check or money order payable to SIRIUS WILDERNESS MEDICINE.

	Course ID:		Total:
	Visa or Mastercard number:		Expiration date: (month/year)

Extra Information

1158 rue Duquette
Val-David QC, Canada J0T 2N0
Tel: (819) 322-5815 • Fax: (819) 322-2019
Email: info@siriusmed.com
TOLL FREE in Canada: 1 (877) 982-0066

Copyright © 1996-2008 Sirius Wilderness Medicine Inc.