ENROLMENT FORM
The Institute (North America) of Biochemic Medicine Inc.
International Academy of Biochemic Medicine
(Dr med. W.H. Schuessler)
STUDENT ENROLMENT APPLICATION and Book order form
Name: ………………………………………………………………….
Address: ………………………………………………………………
Postal code………………….. Country…………………………..
E-mail:…………………………………………………………………..
Telephone :…………………………………………………………..
Facsimile :…………………………………………………………….
Date of Birth: ………………………………………………………..
Occupation……………………………………………………………
Qualifications………………………………………………………..
Please enrol me as a student in the :
Biochemic Medicine Course (Dr med W.H.Schuessler)
Description
QTY
Cost
Total
Biochemic Diploma Course (*included in Diploma Course)
$475
Biochemic Facial Diagnostics *
$ 28
Guide to Biochemic Health Therapies of Dr.(med) W.H. Schuessler
$ 49
Magnesium an Essential Element of Life*
$ 14
A Guide to Biochemic Nutrition*
$ 26
"Ways to Good Health" Magazine (6 issue per year)
$ 33
All prices include shipping
Total Cost (CAD/USA*) All currency converted to Canadian Dollars
Payment options
Paypal
mitchm@telus.net
Visa
Name on Card
VIsa #
Expiry date
Address (if different then on application)
Street
City
State/Prov
Zip/Postal Code
Country
Phone Number
Signature:
Email: info@biochemiccellsalts.com
Fax: 1 604 597 8335
Name: ………………………………………………………………….
Address: ………………………………………………………………
Postal code………………….. Country…………………………..
E-mail:…………………………………………………………………..
Telephone :…………………………………………………………..
Facsimile :…………………………………………………………….
Date of Birth: ………………………………………………………..
Occupation……………………………………………………………
Qualifications………………………………………………………..
Please enrol me as a student in the :
Biochemic Medicine Course (Dr med W.H.Schuessler)
| Description | QTY | Cost | Total |
| Biochemic Diploma Course (*included in Diploma Course) | $475 | ||
| Biochemic Facial Diagnostics * | $ 28 | ||
| Guide to Biochemic Health Therapies of Dr.(med) W.H. Schuessler | $ 49 | ||
| Magnesium an Essential Element of Life* | $ 14 | ||
| A Guide to Biochemic Nutrition* | $ 26 | ||
| "Ways to Good Health" Magazine (6 issue per year) | $ 33 | ||
| All prices include shipping | |||
| Total Cost (CAD/USA*) All currency converted to Canadian Dollars |
| Payment options | |
| Paypal | mitchm@telus.net |
| Visa | |
| Name on Card | |
| VIsa # | Expiry date |
| Address (if different then on application) | |
| Street | City |
| State/Prov | Zip/Postal Code |
| Country | |
| Phone Number | Signature: |
| Email: info@biochemiccellsalts.com | |
| Fax: 1 604 597 8335 | |

















