DOMP Online enrollment

Registration Form - Module II

Instructions: In order to register for the Clinical Training Module II of the DOMP program you must fill out this form as well as submit your payment. Please note that this is an editable PDF, which you can fill out directly on your computer and email to Dorothy Halonen at admissions@lcocanada.com as an attachment.

Program name:
Diploma in Osteopathic Manual Practice (DOMP)
Module II:
Clinical Training
Academic year:
2017
Location/dates (please select YES for one location)

1. Toronto, Canada, April 3-9, 2017
2. Barcelona, Spain, November 12-19, 2017
Student First and Last Name: *
Email: *
Phone: *
Street address: *
City: *
PC / ZC: *
Province / State: *
Country: *
Type of your health care practice: *
Years in practice: *
Module I Completed: *
If no, anticipated date of completion:
Graduate of Associate Certificate in Osteopathy: *
Additional information about yourself (optional): *