Physical Therapy Continuing Education
`Put the Web in your Toobox for Evidence-Based-Practice`

Please provide the following information: ( * indicates required information )

Personal Information * First Name and MI: * Last Name: Spouse/Guest's Name: Address: City: State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist Columbia 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 West Virginia Wisconsin Wyoming Zip: Phone: * Email Address: Class Year:   Please indicate the number of reservations in the boxes: Saturday, August 8   CE Course - Member Alumni Chapter @ $15   CE Course - Non-Member Alumni Chapter @ $60 (includes 1 year alumni chapter membership)