OCR's Banner
Membership Application Form
Please Print or Type:

First Name: _________________________ Initial:______ Last Name:____________________________

Address: _____________________________________________________Apt/Suite #:_____________

City: _______________________________ Prov/State: _______________ PC/Zip.: ________________

Country: ______________________ Email: ________________________________________________

Res.Tel #: ____________________ Bus.Tel #: ____________________ Fax #: ___________________

Date of Birth: (MMDDYY) _______________________________ Profession: _____________________
Please check application applied for:             Note: Membership Year starts in the month joined.
 Check Box Associate
 Check Box Student
 Check Box OCR Certified

Check Box Membership and Printed Newsletter including postage

 Check Box Canada
 - $55.00 Cdn.

Check Box Membership and Electronic Newsletter (Internet)

 Check Box Canada
 - $50.00 Cdn.
 Check Box USA
 - $65.00 Cdn.
 - $65.00 US		  Check Box USA
 - $50.00 Cdn.
 - $50.00 US
 Check Box International
 - $75.00 Cdn.
 - $75.00 US		  Check Box International
 - $50.00 Cdn.
 - $50.00 US

If accepted for membership in the Ontario College of Reflexology, I agree to promote and adhere to the principles and objects of the College as set forth in its By-Laws, Policy & Procedures and Code of Ethics.

  Signature: ________________________________________ Date: ____________________________

Send this Form to:

Payment Options:

 checkmark
Check/Money Order:      VISA      MasterCard      Amex 
Amount:
$ _____________________
Ontario College of Reflexology
 Credit Card #:
_______________________
P.O. Box 220
 Exp. Date:
_______________________
New Liskeard, ON
 Signature:
_______________________
P0J 1P0       Canada
 Name on Card:
_______________________

Go To Top
Home
Index
Contact Us
Go Back

Copyright © 1996-2009 - 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.