Please complete all fields below:
DD/MM/YYYY
i.e. STMHA
First & Last Name
Example: [email protected]. Your submission will be sent to this address.
i.e. ###-###-####
Please indicate how you will be making your payment for this clinic. Cash and Cheque will be accepted on the night of the event. Proof of etransfer payment will be required.
How will you be paying for this Clinic?