Examination Application Form

Select Examination Required:       Written Examination: N101 - Foot Reflexology course N201 - Hand Reflexology course     Nearest Examiner (if available within 100 miles)     Proctored Examination       Practical Examination: N101 - Foot Reflexology course N201 - Hand Reflexology course     Nearest Examiner (if available within 100 miles)     Videotaped Practical Examination   Note:  Examination requirements must be followed.

First Name: ___________________________ Initial:______ Last Name:______________________________

Address: ________________________________________________________Apt/Suite #:_______________

City: ____________________________________ Prov/State: _________________ PC/Zip.: ____________________

Country: ______________________ Email: ________________________________________________________

Res.Tel #: ______________________ Bus.Tel #: ______________________ Fax #: _____________________

Send this Form to: Ontario College of Reflexology P.O. Box 220 New Liskeard, ON P0J 1P0       Canada

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