Application Forms for all CAC Courses


Please Choose

 Individual Jin Shin Do® Courses Application » 
 Relaxfast!™ Chair Massage Application » 
 Five Elements Diploma » 
 Individual Course Options » 


Application for Individual Jin Shin Do® Courses ONLY

To apply by mail

 CLICK HERE for a mail-in application form in MSWord format 

 CLICK HERE for a mail-in application form in plain text format 

To apply online

You are now in the secure area of our website, and all the information you fill in on this page will be sent to us encrypted to ensure it remains private.

Please answer all questions completely.

your full namebirthdate  
streetcity
provincepostal code
OR statepostal code
country
telephone [home][work]
email

Course Selection

Course Location Title Amount Date

* Non-refundable Deposit or full payment must be provided at time of submitting registration form

Method of Payment

Note that you are now in a secure area of our server and this information will be encoded to preserve the security of anything you have filled in on this form:

check one: Cheque Cash/Interac Money Order

VISA MasterCard

name (exactly as on card)

card number expiry (ie, 11/05)

total amount

The Canadian Acupressure College reserves the right to cancel/reschedule courses without notice, and is limited to a refund of the course fee, or if desired, transfer to another course.

If you are applying for the Intermediate Jin Shin Do®: please fill in the prerequisite Basic Jin Do® Instructor's Name and course Date:

Instructor  Date


Where did you hear about us?






Application for Relaxfast!™ Chair Massage Program ONLY

To apply by mail

 CLICK HERE for a mail-in application form in MSWord format 

 CLICK HERE for a mail-in application form in plain text format 

To apply online

You are now in the secure area of our website, and all the information you fill in on this page will be sent to us encrypted to ensure it remains private.

Please answer all questions completely.

your full namebirthdate  
streetcity
provincepostal code
OR statepostal code
country
telephone [home][work]
email

Course Selection

Course Location Title Amount Date

* Non-refundable Deposit or full payment must be provided at time of submitting registration form

Method of Payment

Note that you are now in a secure area of our server and this information will be encoded to preserve the security of anything you have filled in on this form:

check one: Cheque Cash/Interac Money Order

VISA MasterCard

name (exactly as on card)

card number expiry (ie, 11/05)

total amount

The Canadian Acupressure College reserves the right to cancel/reschedule courses without notice, and is limited to a refund of the course fee, or if desired, transfer to another course.

I can bring a massage chair Y N
Where did you hear about us?






Application for Five Elements Diploma ONLY

To apply by mail

 CLICK HERE for a mail-in application form in MSWord format 

 CLICK HERE for a mail-in application form in plain text format 

To apply online

You are now in the secure area of our website, and all the information you fill in on this page will be sent to us encrypted to ensure it remains private.

Please answer all questions completely.

your full namebirthdate  
streetcity
provincepostal code
OR statepostal code
country
telephone [home][work]
email

Course Selection

Course Location Title Amount Date

* Non-refundable Deposit or full payment must be provided at time of submitting registration form

Method of Payment

Note that you are now in a secure area of our server and this information will be encoded to preserve the security of anything you have filled in on this form:

check one: Cheque Cash/Interac Money Order

VISA MasterCard

name (exactly as on card)

card number expiry (ie, 11/05)

total amount

The Canadian Acupressure College reserves the right to cancel/reschedule courses without notice, and is limited to a refund of the course fee, or if desired, transfer to another course.

Where did you hear about us?






Application for Individual Course Options ONLY

To apply by mail

 CLICK HERE for a mail-in application form in MSWord format 

 CLICK HERE for a mail-in application form in plain text format 

To apply online

You are now in the secure area of our website, and all the information you fill in on this page will be sent to us encrypted to ensure it remains private.

Please answer all questions completely.

your full namebirthdate  
streetcity
provincepostal code
OR statepostal code
country
telephone [home][work]
email

Course Selection

Course Location Title Amount Date
Course Location Title Amount Date

* Non-refundable Deposit or full payment must be provided at time of submitting registration form

Method of Payment

Note that you are now in a secure area of our server and this information will be encoded to preserve the security of anything you have filled in on this form:

check one: Cheque Cash/Interac Money Order

VISA MasterCard

name (exactly as on card)

card number expiry (ie, 11/05)

total amount

The Canadian Acupressure College reserves the right to cancel/reschedule courses without notice, and is limited to a refund of the course fee, or if desired, transfer to another course.

Where did you hear about us?

Contact CAC

by phone   250.480.6679

by mail   CAC, #39 - 1957 Guthrie Rd., Comox BC V9M 2J2