Registration

Name *

First

Last

Credentials *

Email *

Phone # *

Practice Name *

# of Clinics in your practice *

Practice Website *

Choose either on-site training or BrainyEX hosted training

I am interested in scheduling an on-site training for my practice. Please contact me for scheduling.

# of Attendees *

Training Location *

$3000/Practice* + Travel Expenses

I am interested in attending a BrainyEX Hosted Training

# of Attendees *

Training includes up to 2 staff; please specify # if additional staff *

$1500 Each Practice, includes training for up to 2 staff. Additional staff are $500/ea

Email us at brainyexprogram@gmail.com OR steffbiz@gmail.com for BrainyEX Hosted Courses.

Comments *

NOTE: After submitting your registration form, a BrainyEX representative will contact you soon with more details, including payment information.