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International Academy ofVeterinary Chiropractic
Dorfstr. 17 27419 Freetz,
GERMANY
E-mail: IAVC2004@hotmail.com
Tel: (0049) 4282 590099
Fax: (0049)4282591852
Course / Module Registration
Basic Veterinary Chiropractic Course
in Sittensen, Northern Germany
Please print clearly 
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Title Family/ Last name First name Date of birth
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Post address Country
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Phone Mobile Fax
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E-mail Profession (Vet, D.C.) / further degrees
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Veterinary or Chiropractic training at (school attended). Date of completion
We prefer E-mail as the main form of contact. If you prefer another means, please indicate how we should alternatively contact you: О Mail О Fax
Course / Module Fees: I intend to pay for (please checkmark):
Course / Module Fees: I intend to pay for (please checkmark):
О Single Module: Module I: (Sacropelvic, April 1rst- 5th, 2009)
О Entire course prepaid:
(Module I: April 1rst- 5th, 09; Module II: May 13th -17th,09;
Module III: June 24th- 28th, 09; Module IV: July 29th - August 2nd, 09;
Module V: September 9th- 13th, 09)
I intend to pay by (please checkmark): О Cheque. О Bank transfer.
Fees are refundable, less 20%, up to two weeks prior to start of modules. No refunds less than two weeks prior to module start, but fees paid can be applied to a future module.
Fees: Single Module: 950 € Entire course prepaid: 4500 €
Please make bank transfers to:
International Academy of Veterinary Chiropractic (IAVC), Dr. Donald Moffatt
Branch (BLZ): 24151235 Sparkasse Rotenburg-Bremervörde, Account No. 28005338
BIC (SWIFT) Code: BRLADE21ROB IBAN Code: DE 24241512350028005338
Please make cheques payable to:
International Academy of Veterinary Chiropractic (IAVC), Dr. Donald Moffatt
Professional Diploma or License Copy required:
● A copy of your current license or diploma is required with registration.
(Course is open to doctors of chiropractic (D.C.s) and veterinarians only.)
Date and Signature:….......................................................................................................... |