Register

*Required
* First Name:
*Last Name:
*PT License #:
*State:	Exp. Date*:
*Email Address:
*Personal Phone:
*Work Phone:
Mailing Address
*Address1:
Address2:
*City:
*State:
*Zip Code:
Work Information
Clinic Name:
Address:
City:
State:
Zip Code:

Courses:
Message:
Cancellation Policy:	Cancellations must be received in writing 8 days prior to the course. A refund minus a $60.00 processing fee will be issued.. Cancellations received within 7 days are non-refundable.

Please note your registration is not complete until we receive payment in full and your physical therapy license number is verified. If you are out of state please fax a copy to 916-355-8196. If we can not verify your number online you will be asked to fax your license.