Applying Cutting-edge Research to Everyday Practice
Registration Form

Please print or type in the date and location of the seminar you would like to attend:

2014 Seminars

Seminar Date:
Seminar Location:

(Please Print)

Name:________________________________________________ Phone: ( ______ )_____________________________

Address: _________________________________________________________________________________________

City________________________________________State:___________________ Zip Code:______________________

D.C. License #:_______________________________ Birth Month: ___________________________________

Full Payment by:

Check    Money Order  

VISA     MasterCard    American Express

Name on Card:_________________________________________ Card Number:_________________________________

Exp. Date:_______________________________ Signature:_________________________________________________

Make Checks Payable To:
Life Chiropractic College West
Division of Continuing Education,
25001 Industrial Boulevard
Hayward, CA 94545

For Registration Information call (800) 788-4476 ext. 4508 or (510) 780-4508
Form can be faxed to (510) 780-4518 Continuing Education Department

Every attempt is made to offer this program as announced. Life Chiropractic College West reserves the right, however, to adjust program faculty, locations, dates, times and tuition to accommodate unanticipated occurrences and to cancel due to insufficient enrollment. We will only notify advance registrants of any cancellation or program changes. Life West is not responsible for any expenses incurred by registrants due to adjustments or cancellations. A $50 processing fee will be charged for refunds when a registrant provides written notice of cancellation at least one (1) business day prior to the seminar start date. Registration is nonrefundable if the program for which it applies is conducted as scheduled; however, registration credit may be given for attendance at a similar program at a later time or at another location, minus a $25 transfer fee.