Please be sure to submit your dossier, copy of license and APTA card (if applicable) in addition to payment!
Marijean Piorkowski, PT, MS, DPT
PLEASE DO NOT REGISTER ONLINE IF YOU INTEND TO PAY BY CHECK! Thank you.
To register, each participant must submit:
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.Registration Fees:
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)
Discounted rates are available for facilities registering more than 5 employees for the same course. Discounts are applied to the applicable participant rate. All group registration must be sent together:
10% for groups of 5-9
15% for 10-14
20% for 15 or more
Send all registration materials to:
IACCC CCIP Administrator
1540 East Alcazar Street, CHP-155K
Los Angeles, CA, 90089-9006
Registration & payment must be received by: February 6th, 2017, Monday.
Your spot in the course cannot be guaranteed until payment and a completed dossier are received. Only those persons who receive a confirmation of their registration by e-mail will be considered to be enrolled.
Refunds and Cancellations
Cancellations must be received in writing, and will be granted a full refund until February 3rd, 2017. Cancellations received after February 3rd, 2017 and up to February 17, 2017 prior to the course will receive a refund, minus a $75 processing fee. Cancellations received February 17, 2017 or later are not eligible for a refund.
REGISTRATION CLOSES FEBRUARY 6th, 2017