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Live Course Registration Form
Register for Live OT and PT Management of SCI Course
Course tuition:
Live - $550 Standard, $500 Early (>30 days prior to course) Code "
Early50
", $300 Student or Audit rate (Previous attendee). Groups of
>
5 $25 off each Code "
Group
", or "
Early/Group75
" if registering early
**
If
you have already registered here
and just need to pay,
skip to the payment page
**
*
Indicates required field
Live Course Location:
*
Choose course location
July 20-21, 2024 - Chelsea, MI
September 28-29, 2024 - Postponed
October 19-20, 2024 - Austin, TX
November 9-10, 2024 - Santa Barbara, CA
First Name:
*
(as you would like it to appear on your certificate)
Last Name
*
Credentials (letters after your name)
*
Letters or degrees ie. PT, OT as you would like them listed on your certificate
Email
*
Cell Phone #:
*
We will only use this to contact you regarding any changes to the course you signed up for.
License #:
*
License numbers will be used to report CEUs in states that require it.
State of Licensure:
*
Choose state if applicable
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington D.C.
West Virginia
Wisconsin
Wyoming
Name of hospital/facility/practice where you work:
*
Profession:
*
Choose your profession
PT
PTA
PT Student
OT
COTA
OT Student
Other
Previous Attendees:
*
Please list year and location of course attended.
School attending (students only):
*
Students, please email copy of student ID to
[email protected]
GROUPS - please list names of others in your group separated by commas
*
Groups of 5 or more from same facility, use coupon code
GROUP
at checkout for a $25 discount per participant.
All group participants must register and pay SEPARATELY for the discount to apply correctly.
This discount
does not apply to host facility
participants.
You will automatically receive a free electronic download of our course syllabus.
If you would like to purchase a hard copy of the syllabus for $50, please select the Course + Printed Syllabus option in the shopping cart (after you submit registration). Printed syllabi will be sent to the Live Course.
(Order must be placed 3 weeks prior to course to receive in time.)
Submit Registration
Home
Who Are We?
Course Overview
Locations & CEUs
Brochure
Register for Course
Live Courses
Virtual Courses
Resources
Contact Us
Hosting a Course