Please print out and mail this form if you would like to register for our program. You can also register by phone by calling 800-396-9778 if you are in the United States, or fax this form to: 831-726-3192.

Mailing Address:
Caduceus Institute of Classical Homeopathy
P.O. Box 538
Aromas, CA  95004

Name____________________________ Profession ________________________

Home Address_______________________________________________________

Office Address ______________________________________________________

Office Phone _____________________ Home Phone _______________________

Email Address _________________________ Fax number ______________________

Where did you learn of our program? ___________________________________

Number of years in practice and modalities used __________________________

Previous homeopathic training and experience______________________________________

I am registering for:

__ Module One - Acute Homeotherapeutics
__ Module Two - Chronic Case Taking and Analyses
__ Module Three - Chronic Case Management
__ Module Four - Miasms and Nosodes
__ Module Five - Advanced Topics
__ Practicum Module
__Clinical Module A and/or B
__Case Supervision - Ten Cases with Two Follow-Ups Each

Financial Agreement: Tuition for modules One through Five is $500 each. Tuition for Practicum Module is $ 750, Clinical Module A is $850, and Clinical Module B is $575. Case Supervision is $600. Registration fee for one or more modules at one time is $100. Payment in two or three installments is possible by special arrangement. A refund of the full tuition is offered if you notify us in writing, within 8 days of our mailing of the first session's materials, that you do not wish to continue the course. In this case, the first session's materials are yours to keep and no further materials will be sent. After that time, no refunds are offered. The registration fee is non-refundable. This agreement is legally binding when signed by you and accepted by our program.

Enclosed is my payment of ___________ by (circle one) check / credit card

Visa/MC #                                                                    3 digit security code:
Expiration Date:                                                           ZIP Code on Credit Card Address:

______________________________                    ______________________
Signature                                                                       Date