Please be sure to submit your dossier, copy of license and APTA card (if applicable) in addition to payment!
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Cerritos College
Instructor:
Marijean Piorkowski, PT, MS, DPT
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PLEASE DO NOT REGISTER ONLINE IF YOU INTEND TO PAY BY CHECK! Thank you.
Registration
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:
Karen Campos
IACCC CCIP Administrator
1540 East Alcazar Street, CHP-155K
Los Angeles, CA, 90089-9006
iaccc_ccipadmin@icloud.com
Fax: 323-442-2998
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
