IBUM Course Registration Form

IBUM Course Registration Form

Call 480-270-6090 With Any Questions
Training Dates Available
Request Onsite Training (In Your Facility)
Applicant Information
Trainee Name

First NameLast Name
Phone Number
Format: (000) 000-0000.
Email Address
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Education and Certifications
Educational Institute
Degree/Certificate
Occupation
Company Name
Other Certifications
State Licensure (Not Required)
Explain current experience with Hyperbaric Oxygen Therapy
If you are just getting into HBOT, it is okay to list no experience.
Goals for Hyperbaric Certification
Please upload your resume/CV (Not Required)

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Do you have any disabilities, illnesses, medical conditions, personal requests, etc. that may require accommodation. (Dietary Restrictions for Lunch)
If you have any awards, recognition, certificates, please share them here:
Hyperbaric Certification applicants must be greater than 18 years of age.
Medical Facility Details

If currently working in a medical clinic or hospital, please provide the following information
Facility

Location (Country/State)
Phone Number
Format: (000) 000-0000.
Supervisor
Not required
Others
How did you learn about this Hyperbaric Certification course?

Other
If you were referred to our training, kindly provide the name of the referring provider so we can express our gratitude for their support in promoting safe and effective HBOT
Any additional comments or information you would like to share?
Student Signature
Date Signed

MonthDayYear
Date

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IBUM - Functional Medicine Hyperbaric Clinician

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$2,500.00

Intermediate Hyperbaric Technician

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$2,250.00

Home HBOT Training

40 Hour Hands-On Training for Home HBOT

$1,200.00

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