Registration form for therapists

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Registration form for therapists

Dear colleagues,

please fill in the form below and send us your training confirmation to office@logicana.at.

We will give you 5% off your shopping cart for every order.

Please understand if "Sale" or already reduced goods are excluded.

If you already have a registered account with us, please let us know when you send us the training confirmation, then we will change your account as soon as possible.

Attention: If your email address that you use for orders changes, please let us know!

Salutation

First name*

Last name*

Company*

Department

VAT Reg.No.

Email address*

Password* Passwords must have a minimum length of 8 characters.

Your address

Street address*

City*

Postal code

Country*

Shipping and billing address do not match.

Alternative shipping address

Account type*

Salutation

First name*

Last name*

Company*

Department

Street address*

City*

Postal code

Country*

Privacy

By selecting continue you confirm that you have read our data protection information and accepted our general terms and conditions.

Fields marked with asterisks (*) are required.