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First Name:
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Initial:
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Last Name:
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e-Mail:
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Street Address:
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City:
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Province/State:
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Postal Code:
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Country:
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Day Phone:
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Night Phone:
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2. Educational Background:
Please use the space below to detail your college or university background. |
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College / University:
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Address:
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Degree Earned:
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3. Health Care Practitioner Background:
Please use the space below to detail your background as a health care practitioner. |
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Practitioner Title:
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Type of License Held:
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| 4. Please use the space below to state your desire in pursuing this program: |
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| 5. For which courses are dates are you interested?: |
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6. You may submit this form below but as this time payment must be made by postal
mail.
Please include your cheque in the amount of $1467.87 (Can)
a recent photo and copy of your college registration. There is not an application
fee for the Quanta, however, the fee for the course is due upon acceptance and you
will not be enrolled without payment.
CANADA COURSE: Mail to:
OSTEOPATHIC COLLEGE OF ONTARIO
18 Crown Steel Drive, Suite 308
Markham, Ontario L3R 9X8 CANADA
Phone: (647) 477-2071
Fax: (905) 947-1705
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