Curriculum Purchase Request Form | Foot Canada Training

Purchase Options

Please select your prefered method of payment.*

Interac E-transfer

Credit Card

Money Order (an additional administrative fee of $50 + tax will be applied if requesting this option)

Did you receive a promo code? If so, add it here:

Please select the purchase option for which you are eligible (see below for cost and eligibility requirements for each option):*

STANDARD Curriculum License

ALUMNI Curriculum License

Supporting Documents

Once we have reviewed your application we may request applicable supporting documents such as Professional Reference form
or Canadian Association of Foot Care Nurses (CAFCN) membership.

Purchasing Representative Details

This purchase request form is completed on behalf of a:*

If "Other", please specify

If purchasing on behalf of an organization, please provide the name of your organization:

Website

First Name*

Last Name*

Title*

Address*

City*

State/Province*

Zip/Postal Code*

Email Address*

Phone*

Signing Authority

Do you have the authority to sign legal agreements on behalf of your organization?*

Yes

No

If the person completing this form is different than the person who will be signing the licensing agreement, please provide the details for the signing authority below:

First Name

Last Name

Title

Address

City

Zip/Postal Code

Email Address

Phone

Educator

Please provide the name of your Educator:*

Please provide your Educator's Nursing Designation:*

If "Other", please specify

Please provide your Educator's Nursing Registration Number:*

Keep in Touch

Our quarterly e-newsletter is the best way to stay up to date on our available courses, curriculum and textbook, as well as receive information of interest to the foot care nursing community. Would you like your email address to be added to our mailing list? You can unsubscribe at any time.*

Yes

No

PLEASE REVIEW YOUR FORM PRIOR TO SUBMITTING TO ENSURE ALL INFORMATION INCLUDED IS COMPLETE AND ACCURATE.

By completing this Curriculum License Purchase Form you are acknowledging that you have read all the available information on the Foot Canada Training Curriculum page, you or your institution meet the criteria indicated, and you agree to the terms and conditions as outlined.

Review Period

Forms received are reviewed within 1-3 business days. Once reviewed, a member of our team will be in touch.