Registration

    Name*

    Address*

    City*

    State*

    Zip*

    Home Phone*

    Work Phone

    Employer

    Email*

    OTCOTAPTPTACHTOther
    *required

    Years as therapist*

    Type of work setting*

    Number of splints per week:
    Static Dynamic

    Course:

    Course Tuition*

    Date*

    Location*

    Payment Type*

    REGISTRATION/CANCELLATION POLICY
    Enrollment is limited. Early registration is encouraged. Confirmation of registration will be by email. Please make sure you provide a current email address on this form.

    Live courses require a minimum number of participants to operate. You will receive a written confirmation when minimum is met. Do not purchase non-refundable travel until you receive official written confirmation

    If WRITTEN cancellation is received three (3) weeks prior to the course date, a tuition refund less $75 administrative fee will be made. While No Refunds will be given after that time, another registrant may be substituted without additional charge (if 4 weeks prior), or the tuition may be applied to another course.

    We reserve the right to cancel a course at any time. Tuition will be returned to the registrant or applied to a future course. We will not be responsible for any charges incurred by registrant due to cancellation of course.

    FORMS OF PAYMENT:
    Check or Credit Card

    SEND CHECK (payable to Hands On OT) AND REGISTRATION FORM TO:

    Paul Gerstenfeld
    5820 W. 77th Place
    Los Angeles, CA 90045

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