Please be sure to submit your dossier, copy of license and APTA card (if applicable) in addition to payment!
Tri-City Medical Center
Lisa Carroll, PT
Sharon Katz-Kunde, PT, MS
PLEASE DO NOT REGISTER ONLINE IF YOU INTEND TO PAY BY CHECK! Thank you.
To register, each participant must submit via email or fax: dossier, license and, if applicable, APTA card:
1. Dossier typewritten. (download form here Participant Dossier Word.doc ) APTA WILL NOT ACCEPT HANDWRITTEN DOSSIERS.
2. Copy of state license to practice
3. Copy of current (as of date of course) APTA membership card, if applicable.
4. Registration fee-- check payable to IACCC, or payment on IACCC website via Paypal.
Mail check to:
IACCC CCIP Administrator
1540 East Alcazar Street, CHP-155
Los Angeles, CA, 90089-9006
IACCC Affiliate Facility members
$160 (APTA member)
$250 (non APTA PT, non APTA PTA)
$300 (non-PT or non-PTA)
Non-IACCC Facility Members
$275 (APTA member)
$400 (non APTA PT, non APTA PTA) $465 (non-PT or non-PTA)
REGISTRATION CLOSED July 29, 2015