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Licensee Application Form

Thank you for your interest in a BrainRx Licensing Opportunity in South Africa

If you're ready to get started, please complete the Request for Consideration as a BrainRx Licensee form below to apply to become a BrainRx Licensee and open your own BrainRx centre. We estimate this form will take about 10 to 15 minutes to complete.

Please fill it out with as much detail as possible to expedite the consideration and application process, and click "Send my Application" when you are finished. A member of our team will then contact you to schedule a follow-up meeting and to assist you through the application process. 

The information you provide will be kept confidential and is for internal use by BrainRx South Africa and BrainRx/LearningRx International only.


Our next Licensee and Trainer Training workshop (Basic and Advanced Training):

7 - 10 November 2018 (Pretoria, South Africa)


Request for Consideration as a BrainRx Licensee:

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