Examination Application Form

Select Examination Required:       Written Examination: N101 - Foot Reflexology course N201 - Hand Reflexology course N104 - Hand Reflexology course     Nearest Examiner (if available within 100 miles)     Proctored Examination       Practical Examination: N101 - Foot Reflexology course N201 - Hand Reflexology course N104 - 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

Copyright © 1996- - 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.