Please be sure to submit your dossier, copy of license and APTA card (if applicable) to the Administrator in addition to payment!
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Henry Mayo Newhall Hospital, Valencia CA
Instructors:
Marijean Piorkowski, PT, MS, DPT
Dorcas Tominaga, PT, DPT
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PLEASE DO NOT USE THIS LINK 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) 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)
**An IACCC facility is one who takes students from 2 or more IACCC schools AND schedules through the IACCC March mailing process.
Group Discount
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: September 8, 2017, Friday.
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 September 8, 2017. Cancellations received after September 8, 2017 and up to September 18, 2017 prior to the course will receive a refund, minus a $75 processing fee. Cancellations received September 18, 2017 or later are not eligible for a refund.
REGISTRATION CLOSES Sept. 8, 2017
