Form Registration Page – CranioDental Academy of Australasia

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CranioDental Paradigm Registration Page

Workshop Registration Form (#7)

First Name

Last Name

Phone/Mobile

Address

Address Line 1

Address Line 2

City

State

Postcode

Country

How did you hear about us?

Have you completed your undergraduate qualification?

Yes

What type of health practitioner are you?

What is your profession? Please type your answer below:

If you are a local physical therapist, are you able to bring a portable treatment table to the workshop?

Yes

Do you have any dietary requirements? Please enter in the text box below:

Medical history

As there is a practical component to this workshop, we are required to ask some general medical history questions for your safety.

Have you had any physical injuries in the past?

Yes

Have you needed to be hospitalised in the past?

Yes

Have you undergone any form of surgery in the past?

Yes

Do you have any immediate health concerns, or have any concerns regarding being worked on by other attendees?

Yes

Have you had any major dental work done in the past?

Yes

Cancellation policy and consent

This final section outlines our cancellation policy and consent to use your photos or videos for future promotion of courses and events in print or online.

Cancellation policy: If you cancel your registration before 30th April 2025 then a 75% refund will be issued. After this date, no refunds will be issued. Please select "Yes, I agree" to continue.

Yes, I agree

Do you consent for the CranioDental Academy to use your photos or videos for future promotional material in printed or online format?

Yes

CranioDental Paradigm Workshop 31st May - 1st June 2025

Price: $770.00

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