Ontario College of Reflexology - Application for EFC Distance Course

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Application Form for
Entrepreneurial Footsteps Course

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Please enter all of required information:

Note: The course must be paid for in full before the course will be shipped to you. Payment is by certified check, money order or credit card only. No personal checks will be accepted. This form will accept credit card payments only and it will be made in Canadian funds. Your credit card company will automatically convert it to your currency if applicable. If you wish to pay by certified check or money order, print the form located here and return with payment enclosed.
If you are unable to use any of the above forms, you may send an email to:
Select Course Required:

Country Course *Course Cost

Canada EFC course c/w textbook $265.00 Cdn

USA EFC course c/w textbook $275.00 Cdn

International EFC course c/w textbook $300.00 Cdn

  *Price includes course fee, textbook, assignments and S&H.

Enter Your Name: * = Required

Enter Your Address: * = Required

Enter Your City/Town: * = Required

Enter Your Province/State: * = Required

Enter Your Postal/Zip Code: * = Required

Enter Your Country * = Required

Enter Your Telephone #: * = Required

Enter Your Fax #:

Enter Your Email Address: * = Required

  Comments:

Type of payment:
Note: the amount charged to your credit card will be in $Cdn. and will be automatically adjusted depending upon the options you have selected above:

Semi-Secure Form

This form is for those who wish to pay by credit card but cannot use the secure form, or if there is a problem with the automatic processing of the secure form.

To send your credit card information electronically, fill in the required information, including the first half of your credit card number in the first box and the second half in the second box. This will split up your credit card information from possible prying eyes. We will not assume any responsibility for this method.

Select the credit card :
* = Required

Enter the first half of
your credit card # :
* = Required

Enter the second half of
your credit card # :
* = Required

Enter Date of Expiry (MMYY) :
* = Required



Note: By registering for this Distance course, you have read and accepted the terms of the Refund Policy. The applicant hereby acknowledges and accepts full responsibility for payment of the course and any additional costs including collection agency costs should my payment not be accepted by my financial institution for any reason.

If sending by postal mail or fax:

Ontario College of Reflexology
P.O. Box 220
New Liskeard, Ontario
P0J 1P0     CANADA
Fax: 705-648-6247

Copyright © 1996-2008 - Ontario College of Reflexology and Donald A. Bisson
All Rights Reserved. Reproduction in whole or in part in any form or medium without express written permission of O.C.R. is prohibited.