Registration

Name*

Address*

City*

State*

Zip*

Home Phone*

Work Phone

Employer

Email*

OTCOTAPTPTACHTOther

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 Susan Locker) AND REGISTRATION FORM TO:
Susan Locker
Post Office Box 131682
Carlsbad, CA 92013

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